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VIEW OF THE DISEASES 

MOST l'Rl V.U.1A I 

IN "THE UNITED STATES OF AMERICA, 

\T DIFFERENT SEASONS OP THE YEAR. 

// ./.v Ai ■( '01 \\"r OF run MOST IMBROVEB Mivnioi) 
OF TREATING TEEM, 

\ absi ver, not only or THE editor's OWK expeiiience, 

DUT OF THE EXPERIENCE OF SEVERAL PHYSICIANS OF 

D1ST1NGIISHED ABILITIES RESIDING IN THE 

DIFFERENT STATES ; 

INCLVDIXG THE SUBSTANCE OF- ALL THE LATEST AND MOST 

IMPORTANT IMPROVEMENTS THAT HAVE BEEN MADE IN THE 

TREATMENT OF SIMILAR DISEASES IN OTHER 

COUNTRIES. 

COLLECTED AND ARRANGED BY 

WILLIAM CURRIE, 

Fellow of the College of Physicians of Philadelphia, Member of the Ameri- 
can Philosophical Society, Physician to the Magdalen Asylum, Sec. 



" The office of teacher, whether assumed or conferred, can never 
compensate for the living- lessons of experience" Red does. 



PHILADELPHIA 



Published and Sold by J. & A. Y. Humphreys, 'Change Wall, < 
>f Second and Walnut Streets. 



1811. 



&p< 



kbA" 



o<\ 



DISTRICT OF PENNSYLVANIA, TO WIT. 

BE IT remembered, that on the thirty-first day of January, in the thirty- 
******* fifth year of the independence of the United States of America, 
% L. 8. J A. D. 1811, William Currie, of the said district, hath deposited 
******* in this office the title of a book, the right whereof he claims as 

author and proprietor, in the words following-, to wit : 

A View of the Diseases most Prevalent in the United States of America at 
different Seasons of the Year, with an Account of the most improved 
Method of Treating- them. Being an Abstract, not only of the Editors* 
own Experience, but of the Experience of several Physicians of distin- 
guished Abilities residing- in the different States. Including- the Substance 
of all the latest and most important Improvements that have been made 
in the Treatment of similar Diseases in other Countries. Collected and 
arranged by William Currie, Fellow of the College of Physicians of 
Philadelphia, Member of the American Philosophical Society, Physician 
to the Magdalen Asylum, &c. 

" The Office of teacher whether assumed or conferred, can never compen- 
sate for the living lessons of experience." Bed does. 

In conformity to the act of the congress of the United States, intitled, 
" An act for the encouragement of learning, by securing the copies of maps, 
charts, and books to the authors and proprietors of such copies, during the 
times therein mentioned ;" and also to the act intitled "An act supplemen- 
tary to an act, intitled, ' An act for the encouragement of learning, by se- 
curing the copies of maps, charts, and books to the authors and proprietors 
of such copies, during the time therein mentioned,' and extending the be- 
nefits thereof to the arts of designing, engraving, and etching historical and 
other prints." 

D. CALDWELL, 

Ckrh of the District of Pennsylvania 



3.933 51 



xt 



TO THE 



REVD. DR. NICHOLAS COLLIN, 



SIR, 

Presuming on your friendship and complaisance, I 
have taken the liberty of dedicating the following Viexv of 
Diseases, Sifc. to you, as a tribute of respect to which 
ifou are justly entitled on account of your literary and 
scientifc acquirements, and particularly for your philanthro- 
pic inquiries into the most probable means of diminishing 
physical and moral evil, and improving the condition of 
the human race; and for inculcating the rational and 
philosophical doctrine, that "he best answers the end of 
his creation, who contributes most to the welfare of 
the community." 

I am, xvitfi assurances of much respect and esteem, 
Tour faithful and obedient serv't* 

WM. CURRIE. 

Philadelphia, Feb, 1, 1811. 



1 



CONTENTS. 





'ting or Bilious 1 ■'< , 
Pestilential^ or Malignant Yellow /" 

litis, or Inflammation of the Brain 
Cephalitis, or that Affection of the Drain which pre- 

v Hydrocephalus Interims, or Internal Dropsy 
of the Brain ...... 

lanche Tonsillaris, or Inflammatory Quinsy 

Cynanche Trachealis, or Inflammation of the Tra- 
chea, commonly called the Croup or Hives 
Pneumonia, Including Peripneumony and Pleurisy, 
Pneumonia Xotha, E$?c. .... 

Gastritis, or Inflammation of the Stomach 
Enteritis, or Inflammation of the Intestines 
Hepatitis, or Inflammation of the Liver 
Rheumatism ...... 

Gout ........ 

Erysipelas, or St. Anthony 9 s Fire 
Epistaxis, or Flux of Blood from the Nose 
Haemoptysis, or Flux of Blood from the Lungs 
Phthisis Pulmonalis, or Consumption of the Lungs 
Catarrh, or Cough, commonly called a Cold 
Influenza, or Epidemic Catarrh 
Dysentery, or Bloody Flux . , 

Cholera Infantum, or Vomiting and Purging of Chil- 
dren ........ 

Bilious Diarrhcea of Infants and Young Children 



Page 
12 

. 30 
51 

. 86 



89 
100 

103 

114 
126 
130 
134 
141 
142 
145 
151 
152 
159 
178 
188 
204 

221 
227 



ERRATA. 



Page 43, for egei* read xger. 

for sequiter read sequatur, 
44, for egrotus read aegrotus. 
101, for borax read boracis. 

121, for balsa read barley. 

122, for empiema read empyema. 

152, for hemoptysis read haemoptysis; and in other place 

where it is printed with an e instead of <c. 
165, for parenchimatous read parenchymatous. 
184, for cochliaria magna read cochlix magnx, 
187,/or alba read albi. 
218, for aquilla read aquila. 
221, for gallae read gallar. 

234, for par read pur. 

235, for magnesia read magnesia*,. 

The reader is requested to correct any other errors that may occ 



PREFAC1. 



11 AN ING had frequent opportunities, in the course oi 
more than thirty years practice, among different descriptions 
of people, of observing the relative success of different reme- 
dies and methods of treating the diseases most prevalent in 
Philadelphia and the adjacent country, at different seasons of 
the year ; and having had favourable opportunities, from fre- 
quent consultations, with some of the most experienced and 
best informed Physicians of Philadelphia, and from many 
years correspondence with Physicians of distinguished abili- 
ties and established character, residing in other States, of 
acquainting myself with the result of their experience and 
observations, and of comparing them, as well as the result of 
my own practical observations, with the practice and opinions 
of the most approved medical writers of Europe, (whose 
publications I have had constant opportunities of consulting 
at the very excellent Library of the Pennsylvania Hospital) ; 
and presuming, that the publication of the result of infor- 
mation derived from such sources, would be acceptable to 
Physicians in general, and to the junior and less experienced 
members of the profession in particular, and especially to those 
) are precluded by situation, from ready access to public 
libraries, I have been induced by these consideration.", to pub- 
lish the following abstract of the. information which I have 
acquired relative to the history and treatment of the diseases 



6 PREFACK. 

that are most prevalent in this country at -different seasons of 
the year, together with the substance of all the latest and most 
important improvements that have been made in the treatment 
of similar diseases in other countries. And as I can with 
truth assure the reader, that I have neither proposed nor di- 
rected any remedy or method of treatment that has not been 
repeatedly confirmed by my own experience, or by the experi- 
ence of those " who make truth their aim, the public good 
their end," I can recommend the adoption of a similar method 
of treatment to others, from a conviction that they will find 
it, as I have done, more efficacious than any other method 
that has hitherto been made public. 

As among the numerous difficulties which attend the prac- 
tice of Physic, a very considerable one frequently arises from 
the resemblance of the symptoms of several diseases, which 
differ essentially in their nature from one another, whereby 
the most cautious and experienced are "sometimes deceived, I 
have endeavoured to the best of my abilities, to give a faith- 
ful transcript of the diagnostic, or distinguishing symptoms 
of the diseases, that I have exhibited a view of in the follow- 
ing pages, without troubling the reader with a prolix and 
tedious detail of such symptoms as are common to other dis- 
eases : I have also endeavoured to point out the effects of 
remedies and the circumstances in which they operate with 
most certainty, from facts which have been confirmed by my 
own practical observations, or the practical observations of 
those on whose judgment and fidelity I can safely rely, with- 
out having recourse to abstract reasoning to account for the 
manner of their operation, as I am convinced that for w r ant of 
strict attention to this circumstance many Physicians of the 
greatest ingenuity have proved the most unsuccessful inter- 
preters of the language of nature. 






Hut though I consider experimental inquiries as the only 

direct road to certainty, I l>\ no mem consider theory n ;» 
useless auxiliary. — Por without reasoning from effects to 
the judgment, in tin- arrangement of 
application of principles deduced from facts, to 
pgrtj the Physician would have, like the Lawyer, 

to depend upon the strength and vigour of his memory for 

date and guide his practice, otherwise he 
rid be under the necessity frf trusting to conjecture, and 
ibing * random. 

The Empiric from ignorance of the nature of different dis 
s, prescribes only to the leading symptoms, without refer- 
ence to the proximate cause, or that particular condition of 
the whole, or part of the system, on which the existence of 
the symptoms depend, or are continued. — The confusion, un- 
certainty and danger of such practice is too obvious to require 
particularising. — But theory to be of use, must be derived 
from induction, or conclusions drawn from authentic and 
established facts. In this way, it becomes not only a useful, 
but an indispensible auxiliary to experience, and therefore 
should never be divorced from it. 

A constant and diligent attendance on the sick, may instruct 
us in the external aspect of diseases, and enable us with some 
degree of certainty to prognosticate their issue ; but without 
the exercise of the understanding in reflecting on their causes 
and nature, it will never furnish us with any other than the 
mere fortuitous means of relieving them, as is finely exempli- 
fied by Dr. Herdman in his account of illiterate nurses, who 
persist in managing infants agreeably to long established cus- 
tom however improper and irrational, because they have been 
long in the habit of managing them in that particular way, and 
therefore dignify it with the imposing tide of experience ; 
whereas it is only habit founded in caprice and continued 
through ignorance and prejudice. Experience properlv sr 



8 PREFACE; 

termed, does not consist in habit or a mere routine of the 
same practice — it consists in retaining, changing, or varying 
our practice, according as repeated trials, and impartial ob- 
servations of the comparative effects of those trials point out 
that which ought to be preferred. The effects of thunder and 
lightning were long observed before Dr. Franklin's time ; but 
till he investigated and discovered their nature and cause, 
no one ever thought of the means by which they might be 
disarmed of their destructive power- 
Having in compiling the following abstract, endeavoured 
to the best of my judgment, to separate facts from conjec- 
tures, and truth from the infinitude of error, with which it is 
blended in most of the systems of physic that I am acquainted 
with, I shall make no apology for laying it before the public, 
as I presume the importance of the facts which it contains, 
and the utility of the design, will more than compensate for 
the defects of the execution, in the estimation of those who 
prefer truth however plain and unadorned, to fiction, though 
decorated with all the flowers of rhetoric or all the embellish- 
ments of art. 

As errors and imperfections, however, will doubtless be 
found in a work which has for its subject an Art that is 
daily receiving additional improvements, and which embraces 
such a variety of objects, (though I have taken all the care 
in my power to guard against their admission,) I request 
every reader that is a competent judge of medical subjects, 
who discovers any error or mistake that has a tendency to 
injure or mislead, as he values the welfare of his fellow 
creatures, to communicate it, without delay or reserve, that 
it mav be corrected in a future edition. 



INTRODUCTION. 



LHE diseases, most prevalent in the range of country in- 
cluded within the limits of the United States, from Novem- 
ber to July are, catarrh or inflammation of the mucous 
membrane of the bronchiae;* pleurisy and peripneumony, or 
inflammation of the pleura and lungs ; hepatitis or inflamma- 
tion of the liver; cynanche tonsillaris or inflammation of the 
tonsils uvula and fauces ; cynanche trachealis, or inflamma- 
tion of the trachea, commonly called the croup or hives ; gastri- 
tis and enteritis, or inflammation of the stomach and intestines ; 
hepatitis or inflammation of the liver ; rheumatism or inflam- 
mation of the muscles of the limbs and other external parts 
of the body ; arthritis, gout, or inflammation of the liga- 
ments, more especially of the small joints; erysipelas or in- 
flammation of the skin ; epistaxis or haemorrhage from the 
nose ; haemoptysis or hoemorrhage from the lungs ; and the 
phthisis pulmonalis or consumption of the lungs ; the cholera 



' This disease however is most prevalent In the months of November and 
December, when the weather is most variable. The same remark applies 
to the croup. 



10 

and diarrhoea from the middle of July to the middle of Sep- 
tember, particularly among infants and young children ; the 
dysentery from the beginning of August to the middle of Sep- 
tember, particularly when long protracted heat and drought 
are succeeded by cold and wet weather of several days con- 
tinuance ; the intermittent, remittent or bilious fever, from 
the middle of August to the end of October ; the malignant, 
yellow or pestilential fever, which has occasioned such deplo- 
rable mortality of late years has been confined almost exclusive- 
ly to the seaport towns and cities, and has prevailed only in the 
summer and two first of the autumnal months ; the typhus or 
continued fever, with nervous putrid or malignant symptoms, 
only occurs in confined situations crowded with people, where 
ventilation is in a great measure excluded, and cleanliness 
neglected ; the cynanche scarlatina or scarlet fever, with ulcera- 
ted sore throat being a contagious disease does not occur every 
year, but when it does occur, it becomes most prevalent in 
spring and autumn, and in the latter season it is sometimes 
accompanied with putrid or malignant symptoms. This dis- 
ease being accurately described by several European writers, 
is omitted here. 

Having enumerated the diseases that are most prevalent in 
this country at the different seasons of the year, I shall now 
proceed to give a concise description of their usual symptoms, 
and an account of the method of treatment which has been 
found most uniformly successful by physicians of the most 
distinguished abilities and extensive experience in this coun- 
try, as well as by myself; I shall not however treat of them, 
according to the preceding enumeration, but (for the sake of 
those who study the healing art systematically), according to 
the arrangement of the late illustrious Dr. Cullen ; all of 
which, excepting the cholera and diarrhoea, are included 



11 ' 

in thi- first class of his nosology and the five iollov 

i / . 

1st, Febris, or fever without local affection) of which there 
ral genera and species, originating from differ* m 

can 

I, Phlegmasia, or local pain and inflammation, constantly 

accompanied with fever. 

od, Exanthemata, or an eruption of the skin more or less 
extensive, accompanied with or preceded by fever. 

4th, Haemorrhagia?, or discharges of blood accompanied 
with or preceded by fever. 

5th, Profluvia or preternatural secretions of mucus accom- 
panied with fever, of which the catarrh and dysentery 
are genera. 

The cholera and diarrhoea belong to the class neuroses or 
second class in Dr. Cullen's nosology and order spasmi. 



The cholic and tetanus, &c. are also genera of the same 
vlass and order. 



12 



CLASS I. 



PYREXIA 



RDER I.- — FEBRIS. 

The diseases of this class are divided into several orders y 
genera and species ; of which fever is placed in the first or- 
der, and generally begins with a distressing sense of cold, 
which very frequently proceeds to a rigor or shivering accom- 
panied with a small low frequent pulse, shrinking of the fea- 
tures and a livid colour of the skin, which, after a certain 
period, shorter or longer, in different persons, are succeeded 
by an increase of heat and thirst, greater fulness of pulse and 
enlargement of the features. 3 * 



Genus I. 

OF INTERMITTENT FEVER. 

A fever of an intermitting or remitting type or form is an 
endemic of America, and is more or less epidemic every year 
during the autumnal season in all low and moist situations in 

* According to Dr. Wilson pyrexia should be divided into two classes, 
viz. febris idiopathic^-uid febris symptomatica, of which last the phleg- 
masia, hemorrhagic and profluviae are genera. 



Continent ; it is also observed in almost all 
the seaport towns during tin ias a, more particularly in 

those where putrinable materials are pennitted_to accumulate. 

This disease in the form of a quotidian is frequently ob- 

ed also in the vernal season* hut at this season it is very 
tor any to be affected with it, excepting those who had 
affe c t ed with it the preceding autumn. The most usual 
intervals between the fits of a pure and regular intermittent 
are twenty-four or fort) -eight hours, the latter of which is 
called the tertian period and is the most frequent ; the for- 
mer is called the quotidian. The paroxysms or fits of re- 
gular intermittents are always finished in less than twenty- 
four hours. But when the hot or sweating stages of the 
paroxysm do not entirely cease before twenty-four hours 
from the beginning have terminated, they almost invariably 
suffer before that time a considerable abatement or remis- 
sion of their violence ; and at the return of the quotidian 
period the patient for some time is affected with a greater sense 
of debility and oppression and is more restless and uneasy : 
soon after which the febrile symptoms all increase in force 
with a diminution of the debility and oppression about the 
praecordia, and of the sickness and propensity to vomit which 
usually occurs in the cold or forming stage of the fever. This 
form of fever is properly denominated remittent. The type 
of this kind of fever is generally changed in its course in the 
following manner ; the tertian is changed into a quotidian, 
the quotidian into a remittent, and the remittent into a more 
continued form. In all these cases the fever has its pa- 

sms continued longer than usual before it changes i: 
type of more frequent repetition. 

The tertian while it has a longer interval iias a longer and 
more violent cold stage than the quotidian ; and when a quar- 



14 

tan occurs which has an interval of seventy-two hours between 
each paroxysm, it has a much longer and more violent cold 
stage and a shorter paroxysm than either. From accurate at- 
tention therefore to the circumstances of the cold stage of 
fevers a physician may generally foretel the nature and type 
of the fever which will follow, provided there be no local 
affection present. 

The paroxysm of the tertian when regular, generally oc- 
curs about noon. That of the quotidian and the remittent 
from six to eleven in the morning. The tertian however fre- 
quently differs in the time of the return of its paroxysms, in 
some cases returning every third day with unequal pa- 
roxysms alternately similar to one another ; sometimes with 
two paroxysms every sixth day and one every third day. The 
two forms of intermittent fever are also frequently united, 
acting as if they originated from different causes having a 
mild paroxysm one day and a more violent one the next in 
the early part of the afternoon. The intermittent also fre- 
quently becomes connected with phlogistic affections in the 
early part of the winter in the southern states, and is then a 
complicated disease, dangerous and difficult to cure. 

It is also varied greatly in its symptoms by the circum- 
stances of constitution ; in persons of an inflammatory dia- 
thesis and plethoric habit, the symptoms resembling during 
the exacerbation, those of the order of phlegmasia?, or the 
violence of those fevers which depend on the inflammation 
of some sensible organ. 

This is particularly the case with persons soon after remo- 
val from high and dry, to low marshy situations. 



lb 

In persons ot different constitutions the symptoms during 
the paroxysm are seldom hiu.li, nor the intermission complete 
the first time of receiving the disease, bat if they recover and 

take n again) the intermissions are generally complete, and of 
the tertian type, especially it' they have been long accuatom- 
ule in marshy situations. It appears from the most 
accurate observations that the longer the paroxysms arc pro- 
ted the sooner they are repeated; from this circumstance 
pears extremely probable that the cause of this difference 
of repetition with respect to time depends upon the cause of 
the protraction of the paroxysms ; and the protraction of the 
p ar oxys ms most undoubtedly depends on the existence of op- 
posite conditions of the human body, viz. on a phlogistic di- 
athesis, or strong tendency to inflammation ; or on a dimi- 
nution, defect or depression of the vital power. 

It is now universally agreed that fevers of the intermittent 
kind originate from a vegeto-animal source, or from the exha- 
lations from the dead parts of either vegetable or animal sub- 
stances in a putrefying state, usually called marsh miasmata, 






16 



OF THE PROXIMATE CAUSE OF FEVER. 

The fundamental operations of life consist in the alternate 
motion and rest of the organic fibre. Causes which disturb 
and interrupt this necessary process occasion disease and 
finally death. The first perceivable cause of fever is a dis- 
turbance of the alternate and regular tenor of the action 
and rest of the irritable or moving parts of the body. There 
are teachers who pretend that the causes of fever is a directly 
stimulating power : others and the more numerous class con- 
tend that it is directly sedative. If the cause were stimula- 
ting, as it must be supposed to be of the nature of other 
stimulating powers, the effects would necessarily begin to 
appear on the application of the cause and would cease upon 
the removal of that cause ; but this is not the case, for per- 
sons are exposed to the cause of intermitting and nervous as 
well as to the cause of eruptive fevers without being sensible 
of any effects for several days. A period always intervenes, 
different on different occasions, but always of sufficient length 
to prove that a febrile action is not the effect of an immediate 
impression, nor when this new or altered action does take 
place is it uniformly increased ; on the contrary, it is often 
diminished in energy and force at its commencement ; reco- 
vering its natural or even an increased degree of energy in 
the course of the paroxysms. On the other hand if the cause 
of fever was a power directly sedative, the operations of 
life must be supposed to become languid in a uniform tenor, 
to stagnate, and finally to cease. In fact, notwithstanding 
the researches of physicians and philosophers of every age, 
the proximate cause of fever still remains in much obscurity. 



17 

, I am of opinion that those who seriously endeai 
mprove the practical part of the profession should aban- 

Mich disquisitions to the professors of medical schools, 

and content themselves with plain reasoning from manifest 

phenomena and careful inductions from the effects most uni- 
formly observed to follow the remedies employed under dif- 
ferent circumstances. The intermittent fever differs from all 
other fevers in its tendency to recur without the application 
of its specific cause as well as in the circumstance of in- 
termissions. Thus, in particular seasons and on changes of 
weather, particularly when the wind is easterly and the air 
damp and cold, those who have lately recovered from it, fre- 
quendy experience a renewed attack. Every paroxysm is 
divided into three distinct stages denoted by Coldness, Heat: 
and Sweating. 

In the rolrl stage the patient is ofFerfed with a remarkable 
rigour or shivering and distressing sense of cold with pain 
of the head, back, loins and limbs, quick respiration and a 
quick small pulse, generally attended with vomiting or ef- 
forts to vomit, the patient frequently throwing up the con- 
tents of the stomach, mixed with bile, after which the cold- 
ness abates or ceases and the second stage begins with a sense 
of heat from die back, and fulness and irregularity of the pulse, 
the pain and the features which were shrunk and pale du- 
ring the cold stage becoming fuller and redder with a white- 
ness of the tongue and an increase of thirst, &c. A profuse 
sweat at length generally flows from every pore, which con- 
tinuing for three or four hours finishes die paroxysm and then 
leaves the patient perfectly free from all morbid symptoms 
for a certain period, excepting a defect of strength and a di- 
minution of his usual appetite. After the sweat has conti- 



18 

• 

nued to flow freely for some time, the urine which was red 
in the second stage deposits a brown coloured sediment. For 
a mo*-e ample and perfect description of the symptoms and 
the crder in which they succeed each other, the reader is re- 
ferred to Dr. Cullen's first lines of the practice of physic 
and to Fordyce's accurate description in his second disserta- 
tion on fever. 



TREATMENT. 

The cure of intermittents consists :-*- 

1st, In shortening the paroxysm and rendering the inter- 
mission perfect ; and, 

2dly, In preventing tke recurrence t/f die paroxysm. 

The first of these intentions may be effected in cases of too 
high action, by blood-letting, cathartics, antimonials, and the 
antiphlogistic regimen, particularly when during the hot stage 
the pulse is strong and full, and the pain of the head and back 
great. These are particularly requisite if during the inter- 
mission the patient complains of pain in his head or back, 
with strong full pulse, and the subsequent intermission is 
imperfect. 

But when inflammatory symptoms are not so manifest or 
urgent, antimonials, or ipecacuanha, administered in such 
quantity and manner as to produce nausea or inclination to 
vomit, but not actual vomiting, will generally suffice for this 



13 

purpose as they generally lv , u lu 

those whi< h DC4 or it tin- crisis <>i & i 

In order to produt he medicine should be 

given in .is large a dose ;i^ tlu i will bear without pro- 

ducing vomiting; that is one-third or one-fourth of a grain 
of tartarised antimony, or ■ grain and a half or two gi 

of pulvia ipecacuanha? or some other such remedy in the sanv. 
proportion should be exhibited at die beginning of the hot 
stag* pealed every two or three hours afterwards till 

the fever intermits. 

If profuse sweating should be the consequence he should 
remain in bed until the fever goes entirely off. 

When a perfect crisis or intermission is not produced, con- 
tinuing these medicines during the remission produces bene- 
ficial effects by taking off what remains of the paroxysm and 
by diminishing the force of the next paroxysm ; they also 
tend to lessen the power of habit in producing subsequent 
paroxysms. In these circumstances they may be repeated 
every four, five or six hours, till more perfect intermissions 
are obtained. When however the paroxysm is protracted, 
not from an inflammatory diathesis, but from depression of 
strength or constitutional weakness, which is indicated by a 
weak, small and quick pulse, great languor or faintness, op- 
pression, restlessness and frequent sighing ; — -evacuants, seda- 
tives, and other debilitating remedies are improper, instead 
of which warm pediluvia, blisters, vinous drinks, and small 
doses of volatile alkali, camphor or ether, &c. should be sub- 
stituted. 



20 

When the intermissions are complete, the cure is generally 
rendered more certain and expeditious by the exhibition of 
an emetic and a mercurial cathartic. 
§,. Tart. Emet. gr. vi. 
Aq. comjnunis §iij. 
Capiat cochlearia duo statim et cochleare unum omni 
quarta parte horae donee, operaverit, tunc potatur aq. tepid, 
vel thea chamomel, frequenter. 

The best time to exhibit the emetic is generally at the end 
of the sweating stage, though some prefer giving it two or three 
hours before the cold fit is expected, and I have frequently 
known it suspend the fit where exhibited at that period, 
when thirty or forty drops of tinct. opium have been taken' 
immediately after its operation, the patient at the same time 
lying in bed warmly covered, . and drinking warm palatable 
drinks, moderately stimulating, at short intervals, such as 
snake-root tea, wine whey, or weak negus, &c. 

A purge should always be given when necessary, soon af- 
ter the termination of the paroxysm, unless the febrile symp- 
toms are very violent, and indicate an inflammatory diathesis, 
which, when the disease occurs in the spring season is gene- 
rally the case, when bleeding should be premised, and will be 
most effectual during the hot staged 

From thirty to forty grains of rhubarb, and from two to 
five grains of calomel made into pills by rubbing them toge- 

* Dr. Parkinson in his Medical Admonitions mentions an instance of a 
person dying convulsed in consequence of being bled during the cold stage 
of an intermittent, 



ther in a mortar, with a little water* will 

ible as any other, adjusting the quantity to age, strength 
and constitution of the patient 

U a milder purge is required numerous formul 

found in the London or Edinburgh Dispensatories, and in 
the works of most practical writers. 

Among the remedies for preventing a recurrence of pa 
, the Cinchona or Peruvian bark has for a long time 
borne the preeminence. When the hark is employed, a drachm 
of it reduced into very fine powder should be exhibited im- 
mediately after the cessation of the paroxysm, (unless in cases 
where its continuance evidently depends upon phlogistic dia- 
thesis), and it should be repeated during the intermission 
even- two hours at least; the stomachs of most persons will 
bear this dose if mixed with sweetened water, snake-root 
tea, strong coffee or simple cinnamon water. If it will bear 
a larger dose two drachms at the end of every three or four 
hours would be preferable. 

The exhibition of the bark at short intervals should not 
be omitted during the intermissions ; therefore if the patient 
falls asleep he should be awakened at the proper time for 
taking it. 

The bark should be continued till within an hour of the 
time that the commencement of the paroxysm is expected, 
when it should be omitted, and from fifteen to thirty drops 
of laudanum in the generality of cases should be given in 
cinnamon or mint water and sinapisms applied to the wrists 
and ancles. If no appearance of the disease occurs at the usual 



22 

period, it should still be continued during the time that the 
next paroxysm should have occurred. For if the remedy 
has had sufficient efficacy during the time of one intermis- 
sion to prevent the return of the next paroxysm, it will cer- 
tainly during the term of the following intermission have 
power to prevent the subsequent paroxysm. 

In a regular tertian this is always the case, and very fre- 
quently in a quotidian. By these means the stomach has 
time to clear itself of the former doses before fresh ones are 
taken, and the sense of weight and uneasiness arising from 
large and frequent doses has time to go off. 

If no traces of the paroxysm have appeared the stomach 
is left capable of digesting food taken during the interval, or 
if the patient's sleep is very much disturbed time is given for 
repose. 

When a paroxysm of an intermittent has been prevented 
by the bark, it frequently happens that if it be discontinued 
abruptly some slight appearances of a paroxysm will occur 
about the usual time of its occurrence, when it is not inter- 
rupted. 

"When slight symptoms of the return of the disease occur, 
such as languor, dull pain in the fore part of the head and 
small of the back, with a disinclination to exertion, they are 
generally succeeded in a few days by a complete paroxysm, 
and the disease proceeds as if it had never been suspended. 
Several means have been employed to prevent this reproduc- 
tion of the disease, such as from twenty to forty drops of 
the tinct. opii an hour before the usual time of its recurrence. 



jmm t and hands at i rime in the hot 

Lath, the appKcal or other rubefacients t© 

the , the pressure of a tourniquet upon the 

Adopting the practice of Dr. Trotter in such cases, I h;i\ 
D thirtv drops of the tinct. opii to my patients the mo- 
ment they felt the first approach of the cold fit. 

I f the first dose does not bring on some warmth in the 
e of ten or fifteen minutes, ten drops were directed to 
be taken in the same manner even' quarter of an hour till 
they produced the desired effect. There will seldom be oc- 
>n to exceed sixty drops in the space of an hour, as the 
medicine seldom fails to give relief in that time. In a few- 
minutes from the exhibition of the tincture an exhilaration 
of spirits is generally perceived, which is quickly followed by 
a relaxation of the surface, the countenance appears cheerful 
and a flush spreads over the cheeks. The pulse from being 
weak, quick and sometimes irregular, becomes more slow, 
full and equal, an agreeable warmth is diffused over the 
whole frame, and every unpleasant feeling vanishes, some- 
times in half an hour. As soon as any symptoms indicate 
the approach of another paroxysm, if the intermission has 
D per/ect or nearly so, the tinct. opii should be repeated 
in the same manner and will generally be attended with equal 
success, so that the patient seldom experiences much tremor 
or shakings. 

The bark should also be continued in the same doses as at 
first at the time that would have been the intermission after 
the paroxysm that was prevented by it, employing it as fre- 



24 

quently as during the time of the first intermission, observ- 
ing to discontinue it during the time that the subsequent pa- 
roxysm should have existed ; and observing the same process 
during the next intermission ; that is if the paroxysm of a 
tertian had commenced at twelve o'clock at noon on Sunday, 
and had completed its stages by midnight, a drachm of the 
bark should be exhibited at one o'clock on Monday morning 
and continued every two hours till eleven on Tuesday morn- 
ing ; it is then to be discontinued till one o'clock on Wed- 
nesday morning, when it is to be given in the same manner 
till eleven on Thursday morning ; it is then to be disconti^ 
nued again till one on Friday morning, and then to be exhi- 
bited till eleven on Saturday, and afterwards discontinued 
altogether for six days. An ounce of bark should then be 
exhibited in the course of the day for two days, and to pre- 
vent a relapse again in the same manner after an interval of 
six days more. 

If the bark should affect the intestines as a purgative, it 
is a common and proper practice to give opium to prevent 
this effect ; as the opium should be employed so as to act on 
the intestines constantly and with efficacy, a third part of a 
grain of opium, fifteen of confectio opiata or ten drops of 
tinct. opii should be given and repeated at the end of every 
fourth or sixth hour, and may be combined with the dose of 
bark which falls in at that period. 

When on the other hand the patient is costive during the 
use of the bark, twenty-five or thirty grains of rhubarb made 
into pills with Castile soap may be given at bed time with 
any thing agreeable, or five grains of aloes and one of calo- 
mel made into a pill with a little water. When these are not 



able any other mild laxative may be subsli 

toted. 

It tfae stomach will not bear a sufficient quantity 01 
quent repetition of the bark in substance, it may be given 
in decoction or infusion, either alone or combined with 
quassia root, culumbo or gentian and orange peel; and in 
where the vital power is manifestly deficient, snake 
root should be joined with the other ingredients, and a table 
spoonful or two nf Madeira, Port or Sherry wine should be 
^i\ en with or immediately after each dose. The manner of 
making the decoction or infusion may he seen in the latest 
London Dispensatory. It is however certain from the ob- 
servations of Dr. G. Fordyce of St. George's Hospital, 
that the powder is much more powerful in preventing the 
return of the paroxysms of an intermittent than any other 
preparation of it. 

If the stomach will not retain it in any of these forms, 
or the patient has taken an insuperable disgust to it, it may 
be employed by clysters with nearly equal efficacy. 

For this purpose half an ounce of bark in very fine 
powder, mixed with half a pint of sago, panada, gruel or 
barley water, with or without spices, according to circum- 
stances, may be administered every four hours during the 
intermission of a tertian, and every three hours during the 
intermission of a quotidian, observing the same future pe- 
riods in administering them as directed when the bark is 
taken into the stomach. If the clysters should not remain 
with the patient, twenty drops of laudanum should be ad- 
ded to every one, or ten drops mav be given by the mouth. 



26 

in cinnamon or peppermint water, an hour before receiving 
each clyster. 

When the disease appears to be rapidly verging to the 
remittent type from manifest defect of vital power, the 
most effectual remedy for arresting its progress that I have 
ever seen employed was a combination of calomel and 
opium in the proportion of one grain of the former to one 
fourth of a grain of the latter, and exhibited in this quan- 
tity every fourth or sixth hour, day and night, and rubbing 
from a scruple tn a drachm of strong mercurial ointment 
upon the side over the liver twice a day till the effects of 
the mercury become visible in the gums ; the bark in de- 
coction with the addition of wine proportioned to the 
strength and existing sensibility being continued at the 
same time. When the feverish symptoms have been ac- 
companied with strong pulse and burning dry skin, the 
application of linen compresses wet with vinegar and cold 
water to the forehead and wrists have generally modera- 
ted these symptoms. Where, on the other hand, the pulse 
during the hot stage is small and weak, and the heat of 
the extremities moderate, in addition to the employment 
of the decoction of bark, wine and blisters, a gallon or two 
of cold water should be thrown over the naked body of the 
patient at that period of the hot stage when the pain of 
the head, strength of the pulse and heat of the skin are 
greatest, after which he should be wiped dry and put to 
bed, and some agreeable warm stimulating infusion, such 
as sage tea with the addition of lemon juice and white su- 
gar, or weak wine whey given frequently to promote per- 
spiration. 

The ascites which frequently succeeds this fever is ge- 
nerally attended with anasarcous swellings and a paucitr 



thickness of urine , sometimes die intei mittt nt goc* oil 
when the swelling begins, si other times it continues, and 
i s in an irregular manner. These dit)] 

arc not to be cured by purging alone, nor by mercurials, 
but chiefly by the lixivial salts. 

About forty grains of the salt of wormwood or salt of 
may be dissolved in about ten ounces of an infu- 
ithium vulgare, to uhich may be added two 
KpUand gin. This mixture is to be taken a' 
three draughts and repeated daily. The patient will sel- 
dom have occasion for any other medicine except once in 
four or five days half a drachm of pilulae ex colocyn- 
thydc cum aloe for a purge, and in the decline of the dis- 
some common chalybeate. Sometimes the diuresis 
is promoted by swallowing garlic or mustard seed; or an 
infusion of rad raphan rustican in cider. 

"Whe^n the ascites is accompanied with a hard swelling 
of the liver or spleen, the application of mercurial oint- 
ment over those viscera twice a day, or small doses of ca- 
lomel or the blue pill once in twelve or twenty-four hours 
will be requisite. 

Sometimes irregular agues with obstructed viscera, as 
well as dropsies, are removed by r the following composi- 
tion continued a considerable time. 

IJj. Flor. chamcemeli §ss. 
Aq. bullient. 3 viij. 
Macera per dimidium horae et colaturae adde, 
Spir. vin. gallic, veljuniperi |ij. 
Sal. absinth 3i. 
M. dentur quater quotidie, cochlearia, quatuoi- 



28 

If these remedies do not reduce the dropsical swelling, 
or at least diminish it considerably in the course of five or 
six days, the tincture of digitalis and alterative doses of 
calomel should be substituted and given in small and re- 
peated doses for several days, or till its effects upon the 
stomach or nervous system make it adviseable to disconti- 
nue it. 

To prevent the purgative effects of calomel it may be 
combined with a small quantity of opium, and given at bed 
time; and the tincture of digitalis may be given in any 
pleasant draught or drink an hour before every meal, be- 
ginning with ten drops and increasing the quantity at the 
end of every third or fourth day till it removes the disor* 
der, or until it occasions unpleasant symptoms. 






A COLLECTION OF PACTS 

RELAT1V1. 

TO THF. EFFECTS OF CERTAIN PREPARATIONS OF ARSENIC 
1\ 1NTKKM1TTING FEVERS, 

WITH OCCASIONAL REMARKS. 



Though arsenic when taken to a certain extent has 
always been ranked among the most dangerous poisons, 
particular preparations of it have been employed by empi- 
rics for more than a century in the cure of agues or inter- 
mitting fevers ; but it appears from an article published in 
the third volume of the British critic, that it was first in- 
troduced into regular practice in the year 1 774* by a Mr. 
Mowbray, a surgeon at Biggleswade, who for a small sum 
purchased from the widow of a German empiric a recipe 
for the preparation of a remedy which he had employed as 
a specific in the cure of agues, the principal ingredient of 
which was arsenic. 

This recipe Mr. Mowbray, with becoming liberality, 
communicated to several of his medical friends, and em- 
ployed it himself with great success. At that time Mr. 
Mowbray had a shopman whose name was Edwards, who 



30 

usually prepared this medicine. Edwards afterwards setr 
tied at Newmarket and vended this medicine under the 
name of Ague Tincture. This remedy was occasionally 
adopted in the hospital practice at Stafford in the year 
1781-2 and 3. 

In the beginning of 1780, Mr. Hughes to whom Dr. 
Fowler pays a high compliment for industry, attention and 
abilities in his profession, informed him that he had tried 
to imitate these ague drops, and that from a number of ex- 
periments he was convinced they were a preparation of 
arsenic. 

This information directed the attention of Dr. Fowler 
to the use of arsenic in intermittents ; and taking advan- 
tage of a hint given by Dr, Lewis in his dispensatory, he 
thought of preparing a watery solution of it by means of 
the fixed vegetable alkali ; and after many trials of such a 
solution of different degrees of strength, he adopted the 
following formula. 

R. Arsenici albi in pulverem subtilissimum triti. 

Salis alkalini fixi vegitabilis purificati singulorum grana 
sexaginta quatuor. 

Aquae fontanse distillate libram dimidiam. 

Immitantur in ampullam florentinam qua in balneo arena* 
posita, aqualente ebulliat donee arsenicum perfecte solutum 
fuerit, deinde solutioni frigidae adde. 

Spiritus lavendulse compositi unciam dimidiam. Aquse 
fontanae distillate libram dimidiam, plus vel minus, adeo 
ut solutionis mensura libra una accurata sit, vel potius pon- 
dere unciae quindecim cum dimidia. 



This tarmula, Dr. Fowler employed in a very great 
|riei md in the generality of them with the 

most flattering success. In BOSK of th< 

when from inadvci tency or other circumstances it was 
administered in over doses it operated as a violent emetic, 
attended with griping and purging. In seven cases of 
periodical head ach in which he employed it, six of these 
Were radically cured by taking from twelve to twenty drops 
of it twice or thrice a day. He frequently used it from ten 
drops twice a day to twenty drops three times a day, and 
i red agues by both extremes as well as by intermedi- 
ate doses. The latter however he found to be far more 
efficacious than the former ; but this superior success was 
counterbalanced by their operative effects being sometimes 
troublesome and distressing ; hence he gives the preference 
to the intermediate doses which will at the same time in 
general be found to be sufficiently successful. lie recom- 
mends the following doses of the preceding formula as the 
most advantageous and safe, viz.* 

To patients from two to four years of age from two to 
four drops ; to patients from five to seven years of age from 
five to seven drops ; to those from eight to twelve years, 
from seven to ten drops ; to patients from thirteen to eigh- 



• According to Dr. Hill's observations in the 5th vol. Edinburgh Med- 
and Surg. Journal, a single drop or two at most of the arsenical solution 
from a half ounce vial is a sufficient dose for a child three years old, re- 
peated twice every twelve hours ; for older subjects the dose may range 
from two to five or six drops in the same period, and to adults, whatever 
type the fever may assume, from six to twelve drops, from an ounce vial, 
combined with an equal quantity of tinct. lav. comp. tinct. aromat &c. 
at the choice of the prescribe!'. 






■ 32 

teen, from ten to twelve drops ; and to patients from eigh- 
teen and upwards, twelve drops for a dose. These doses he 
directs to be given to adults in a tea cup full of water, and 
to children in a less quantity of the same at stated hours, 
whether they coincide with the paroxysm or not, three 
times a day for five days; 

At the end of that time the fits being suspended, he 
advises the use of the medicine to be omitted for two 01 
three days, and then to be resumed to prevent a relapse* 
When the sensible effects of the medicine were troublesome, 
he either omitted the medicine till those effects ceased, or 
added a sufficient quantity of laudanum to the solution to 
relieve them. 

When a nausea of half an hours duration, a stool ex- 
traordinary a day, or slight griping pains in the bowels fol- 
low the exhibition of this medicine; according to Dr. 
Fowler they scarcely require notice : but when either the 
vomiting or purging becomes distressing or troublesome, 
discontinuing the solution and giving opiates in small doses 
repeated as the symptoms may require, generally affords 
effectual relief. 

The cedematous swelling of the face and eye-lids, which 
sometimes occurs a few days after commencing the use of 
the medicine generally subsides on discontinuing it ; when 
it does not, its removal may be accelerated by emetics and 
cathartics.* 



* This swelling- appears to be owing to the extraordinary effect of this 
remedy upon the exhaling vessels, In consequence of which more fluid 



rsenic in intermit 
-v, prepared according to the above prescription, is not 
only supported b) the testimon} ol Dr. Fowler and ixnold, 
but by Drs. \> ithering, Willan and Hamilton, and by many 
other physicians of distinguished abilities in Europe. 

It has also succeeded in the hands of several of the 
members of the profession in Philadelphia, and particularly 
with Drs. Wlstar and Griffiths, as well as with the editor, 
especially where infants or young children have been the 
subjects of the disease. 

1):. Hamilton lias frequently employed a solution of 
ic in water without the addition of the alkaline salt, 
and is of opinion that it is equally safe as well as effica- 
cious, provided the solution be carefully filtered through 
paper to prevent any undissolved particles of arsenic from 
escaping. 

In no case that he employed this preparation did he ob- 
serve that it produced any permanent ill effect or any tem- 
porary inconvenience except nausea or griping and tenes- 
mus. These by care in the exhibition of the medicine, 
particularly with the first doses, which were always small, 
were prevented from becoming troublesome or in the smal- 
lest degree alarming. 



is exhaled than the 1) mpha. s can readily take up. A lower degree ot 
the action of this remedy on the exhaling or extreme vessels perhaps 
cures the disease by giving tone and excitement, and thereby removing 
the spasm, or stricture, by which the febrile symptoms are supposed bv 
the ingenious Cullen to be supported. 

5 



34 

It is probable, however, that the preparation employed 
hv Dr. Hamilton, from not being united with the alkali, 
ts less steady in its effects, as it is less readily diffusible in 
a farther quantity of menstruum than when in a saline 
state. 

It is a common practice in the state of Delaware to give 
powdered arsenic combined with opium in the form of a 
pill or bolus in doses, to an adult, of one-sixth of a grain 
of the former, and one-fourth of a grain of the latter, re- 
peated two or three times a day ; and in the second Volume^ 
of the Asiatic Researches pills composed of arsenic and 
black pepper made according to the following formula, are 
directed.^ 

But from the distressing and even dangerous effects 
which have been observed by different physicians to have 
followed the too frequent or incautious exhibition of a 
weak filtered solution of this highly active substance, and 
from its well known corrosive effects when applied to the 
surface of the stomach in an undiluted state, I cannot think 
it warrantable to exhibit it in that form. We have the tes- 
timony of Sir George Baker, published in the third vo- 
lume of the Transactions of the London College of Phy- 
sicians, that though a medicine composed of arsenic and 

* "Take of white arsenic one hundred and five grains, black pepper sir 
hundred and thirty grains, beat well in an iron mortar, for four days at 
intervals ; when reduced to an impalpable powder, remove it to a stone 
mortar, add water by degrees, so as to form a mass of pilular consist- 
ence ; make pills of the size of tares or small pulse (about eight hun- 
dred) ; keep them in a dry shady place ; give one, night and morning 
with a little cold water; gentle cathartics precede their use with consi- 
derable effect ." 



opium, the dose of which *w w dropi in wtter. 

, and simiftini lly, in 

nitu-ius; violent vomitings unci d- 

: now and then the effects of it, and in one i 

»wed by a palsy of the lower limbs. 

D . Clark in his obaervatioiU OO diseases of long voyages, 
if arsenic in l'e\ ers sum. times occasions swcl 
id other distressing symptoms. 

Dr. Girdlcstone in a communication published in the fif- 

volume of the London Medical and Physical Jour- 

na lys, he has had several opportunities of observing 

ess, pains of the abdomen, nasal haemorrhage, cough, 

mptoms, and dropsy, induced by the incautious or 

doses of Fowler's solution of arsenic. 

One child lost its nails, hair, and part of its skin, from 

solution, which a lady had given to it in improper 

It occasioned a very great weakness in the bow 

. a gentleman who took twenty drops of it three time* 

a day for more than three months for a leprous affection - 

without curing the disorder as soon as may be generalh 

done w T ith much smaller doses. 

In my own practice I have seldom employed any of the 
preparations of arsenic when the patient could be prevailed 
upon to take the Peruvian bark in sufficient quantity, and 
it could be retained on the stomach ; and when I have em- 
ployed it I have never ventured to prescribe more than six, 
eight or ten drops of Fowler's solution three times a day 
to an adult, without regard to the exacerbations of the fever, 
and from one to four drops to an infant or young child. 



As a vehicle to administer it in, Dr. Girdlestone gives 
the preference to an agreeable spicy decoction or infusion. 
But I have found children take it more readily in a small 
draught of sweetened water, and when it has disagreed 
with the stomach or bowels, which is the only inconve- 
nience I have ever seen produced by it, I have directed it 
to be given in a draught of cinnamon or peppermint julep, 
with the addition of from one to five or six drops of lau- 
danum to each dose, according to the age of the patient and 
severity of the symptoms. 

Though it is often very difficult to determine the credit 
that is due to a remedy in a disease which frequently ceases 
without the use of any remedy, or after the exhibition of 
such medicines as cannot possibly have any share in the 
cure, its cessation being apparently occasioned in some in- 
stances by a change in the temperature of the atmosphere, 
a removal of the remote cause, or a suspension of the 
proximate cause in consequence of some sudden emotion 
of the mind, I have frequently seen the disease in patients 
residing in the marshy tract of ground below the city, in 
seasons when the disease has been remarkably prevalent, 
leave the patient so much sooner after the regular use of 
this remedy for five or six days, than, from the regularity 
of the recurrence of the paroxysms and the increasing de- 
bility of the patients, I have any reason to suppose would 
have been the case if left to take its own course, or if treat? 
ed by any of the remedies in common use except the Pe- 
ruvian bark, that I have not the most distant doubt of the 
cure being produced by the operation of the arsenic. And 
notwithstanding the idea of danger, which is generally as- 
sociated with the name of arsenic, I am perfectly satisfied 
|hat with proper caution and dye attention to its sensible 



red \\ uli equ as man) 

iiher medicines in common use, such 
sulphi ipper, tartarized antimony and opium, all ol 

which in certain doses arc destructive to life. And I am 

m m\ own experience, as wall a. I mm the 

testimony of several eminent, impartial and disinter 
physicians, that it is a very efficacious remedy in th< 
neralitv oi' the ca alar intermittent:-, and in those. 

■ dical head achs which occur in the season when in- 
termittent >st prevalent. 

Dr. Fowler is of opinion that arsenic is also a good re- 
medy in cases of the common autumnal remittents : hut as 
I have never tried it in this form or type of fever, I can- 
not pretend to say whether his opinion is correct or not ; 
but admitting it to be so, 1 should not think myself justifi- 
able in prescribing it in any case where the debility and 
other symptoms indicated great danger, lest from its ten- 
dency to occasion sickness, griping and tenesmus, it should 
increase the debility, and consequently danger, especially 
as my experience teaches me that under such circumstances 
the fatal progress of the disease may be generally arrested 
by injections of bark, the liberal use of wine, and the ap- 
plication and frequent repetition of blisters and sinapisms. 

Certain preparations of mercury are frcqucntlv employed 
by physicians in cases of intermitting fever, and in pro- 
tracted cases frequently with benefit ; but in recent ones J 
hav£ rarely observed this remedy to cure the disease when 
employed in the most judicious manner, or even to suspend 
the return of the paroxysms. Dr. Granger has left testi- 
mony of his having observed the same circumstance, in 
the campaign in Flanders in the year 1748, and we arc in 



38 

formed by Vanswieten in his Commentary on the seven 
hundred and fifty-seventh Aphorism of Boerhaave, that 
the paroxysm of a quartan has continued to return regiu 
larly during a course of salivation, and that he has known 
a tertian arise in the midst of a salivation. 

"When obstructed viscera or dropsy is connected with an 
intermittent, small and repeated doses of calomel, or the 
blue mercurial pill, afford more frequent relief than any 
other remedy. 

"When young children are the subjects of this disease, 
Br. Martin, an eminent physician in Easton on the eastern 
shore of Maryland, assures the editor that he has found a 
dose of calomel if given in the forming stage, very frequent- 
ly prevent it from proceeding any further; his usual dose 
for a child two years of age is four grams. He also adds 
in a letter dated Deer. 21, 1810, that he has "found the 
mineral solution of arsenic very useful in the regular ter- 
tian, and as much entitled to infallibility as any other me- 
dicine in stopping the ague and fever of this type only, but 
the patient is very liable to relapses, and never has the 
same healthy-looking countenance as is apparent in one 
who is in the habit of taking bark." 



3$ 



OF Till 

U TUMNAL REMITTENT FEVER 

USUALLY CALLED 

THE BILIOUS FEVER. 



I'll rs fever, like the intermittent fever, of which it is 
i variety or the same in kind, but differing in degree, 
consist- of repeated paroxysms, without any entire or per- 
fect intermission between them ,* but although the hot and 
sweating stages of the paroxysm do not entirely cease be- 
fore the end of twenty-four hours from the commencement 
h paroxysm, the symptoms of the hot stage remit or 
considerably diminish in violence within that period, and 
at the return of the quotidian period, or somewhat earlier 
in the morning, the paroxysm is in some degree daily re - 
I, and runs the same course as before. 

Mhen in this fever the remission of the symptoms is 
considerable, and the return of a fresh paroxysm is dis- 
tinctly marked by the symptoms of a cold stage at the be- 
ginning of it, the fever generally changes in the course of 
a few days under proper management to a perfect inter- 
mittent. But where (as frequently happens in constitu- 
tions previously debilitated by fatigue, abstemious living, 
&c.) the remissions arc very imperfect and without any 



40 

moisture on the skin, and the returning paroxysm is only 
distinguished by greater languor or debility, sickness at 
stomach, oppression about the region of the heart, and 
paleness of countenance, the disease unless prevented by 
art generally degenerates into a continued type, and when 
it terminates favourably is many days before it comes to a 
crisis or solution. 

The more this disease assumes the appearance of the 
typhus or continued fever, conjoined with symptoms of ge- 
neral debility, and the shorter the remissions and the 
greater the debility the greater is the danger. 

When the disease terminates fatally it is generally to- 
wards the usual time that the paroxysm terminates, or du- 
ring the cold or forming stage. The brain becomes affect- 
ed-— the senses fail — the patient becomes speechless — his 
breathing becomes quick and laborious — he can no longer 
swallow any thing — a diarrhoea mostly attends — his pulse 
ceases at the wrists — -cold sweats break out — phlegm rat- 
tles in his throat — his eyes grow dim and become fixed — * 
the motion of the heart ceases, and he becomes a lifeless 
corpse. 

The causes of the remittent fever are the same with 
those which give origin to intermittents, but acting here 
in a more powerful manner either on constitutions previ- 
ously debilitated or on those with an inflammatory diathe- 
sis at the time of the application of the cause. In many 
cases of those of the first description the accession of every 
paroxysm is accompanied with vomiting of bilious matter, 
from which circumstance this form of fever has very gene- 
rally obtained the appellation of the bilious fiver* 



mittent fever is only ■ of the i 

mittent, and onl) differs from it in degree, is rendered evi- 
dent — 1st, Prom tin- leading symptoms in both being the 
same; 9d, From their changing • JIv into 

other; 3d, From their arising in the same situations, and 
at the same seasons of the \ ear ; and 4th, From their 
yielding to the same treatment. 

The longer and more distinct the remissions, the greater 
is the prospect of a favourable event* 



TREATMENT. 

When the paroxysms are manifestly prolonged by an in 
flammatory diathesis, the signs of which have been already 
mentioned, bleeding, purging, and the frequent exhibition 
of antimonials in nauseating doses, in conjunction with 
cooling drinks, and a very spare and cooling diet, will be 
the most suitable remedies. The bleeding should be repeat- 
ed at short intervals, that is every six or eight hours, and 
especially during the exacerbation of the paroxysm, till 
the fulness and strength of the pulse is sufficiently reduced. 
After which an emetic composed of ten or twelve grains 
ipecacuanhas, and from one to two of tartarized antimony 
should be exhibited, for one dose, soon after the appear- 
ance of a remission, and after the emetic has done opera- 
ting twenty-five or thirty drops of tinct. opii, or from one 
to two grains of opium in substance, with twice as much 
camphor, should be given ; blisters should also be applied 
to the wrists at the same time. 

In many cases where the pulse became tense and hard du- 
ring the exacerbation, I have found the following remedier 



42 

hi conjunction with repeated bleeding, particularly service- 
able in rendering the remissions more perfect. 
&. Calomel. 9i. 
Pulv. jalap. 3ij. 

Antimon. tartar, grs. ii. ad. grs. iv.-— m. f. ch. no. vi- 
Una hora quaque vel secunda sumenda. 

"When these occasion distressing sickness at the stomach 
or puking, the quantity of the emetic tartar is to be dimi- 
nished, or they are to be given at longer intervals. 

This prescription, however, can seldom be persisted in 
more than three days successively without endangering sali- 
vation, as I have frequently had occasion to observe, and 
when it has had that effect, instead of rendering the remis- 
sions more perfect, it has induced an inflammatory diathesis 
and rendered the remissions more obscure, and the exacer- 
bations more violent. "Whenever inflammatory symptoms 
are evident therefore, I have been induced from long ex- 
perience to give the preference to the purging neutral salts, 
or to the following composition. 

§>. Fol. senna?, tamarind, aa 3ij. 
Antimon. tartariz. grs. ij. 
Aq. calid. lb i. 

After these have been boiled in a covered vessel for ten 
or twelve minutes, the water is to be strained off, sweeten- 
ed with sugar, and the patient is to take two ounces, or a 
wine glass full, every hour, till his bowels are freely mo- 
ved J diminishing the quantity or lengthening the intervals, 
if it should occasion vomiting. 

In this manner it may be repeated during the exacerbation 
cf every paroxysm* 



But when the disease comment ea in ■ d< bilitated or infinn 
• titution, bleeding is an improper remedy, and ought nol to 
mployed unless the existence of some local inflamma) 
affection should be joined with the fever. 

But purging has generally been found beneficial at the 
nning of the disease, in cases where thr state of tin 
pulse and heat of the skin have shewn great depression of 
trength. 

fn this stage of the disease from two to four grains of calo 
made into pills, with from fifteen to twenty-five or thirty 
of rhubarb, may be given at one dose with perfect safety; 
though the same medicine at a later period, when symptoms 
of debility have become more evident, might be attended with 
some hazard. 

In cases where bilious evacuations occur daily, the follow- 
ing purgative may be employed with more safety and equal 
efficacy. 

5jo Fol. sennae. §ss. 
Tamarind. $i. 
Vel. christal. tartar. 5ij. 
Aquae, com. Jviij. 

Coque ; cola et solve in liquore manna vel sach. rub. |i. 
Capiat eger hujus decoctionis §ij. 
Hora quaque donee dejectio alvi sequitur. 

Vfter this preparatory process, if no inflammatory symp- 
- -ms exist, the bark should be exhibited every hour during 
:he period of every remission, in as large doses as the stomach 
will bear ; and when it cannot be taken that way it should be 
exhibited in clyster, twice at least, before the next accession of 



44. 

the paroxysm.* If the stomach is disordered and the pulse 
weak, the patient may be purged safely by an infusion of rhu- 
barb and ginger, in boiling water. 

TVine given with the bark during the remission, has also be- 
neficial effects, if caution be observed not to exceed due 
bounds. One table spoonfull under such circumstances, giv- 
ing greater excitement to the debilitated and irritable system 
than a wine glass full in a state of health. 

I have frequently employed the bark during the exacerba- 
tion of the paroxysms, but I am inclined to believe seldom to 
advantage. It is therefore my opinion, that its use should 
generally be restricted to the period of remission, whether 
these are manifest or not. Even during the remission I have 
generally found the bark detrimental so long as the phlogistic 
diathesis (denoted by hard or tense and frequent pulse) existed. 

"When the patient cannot take the bark either in substance 
<or decoction, and cannot retain clysters long enough to be ef- 
fectual even when combined with opiates, the solution of arse- 
nic may be substituted with propriety, only observing to restrict 
it also to the periods of the remission. In some cases calomel 
in small and repeated doses, guarded from affecting the bow- 
els by combining each dose with the fourth or sixth of a grain 

* In cases of diminished arterial strength and disordered stomach which 
indicates an excess of bilious excretion, the following purge is equal to any 
other. 

R. Fol. sennse. oz. ss. 

Rad rhaei. contusat. drs. ij. 

Sem. cardamom, vel. cort. siccat. aurantior. drs* ss.m. 
Coque in aq. com. lb. ss. ad. oz. vj. 
Cola & capiat, egrotus^or. ij. 
Or half the quantity every two hours, till it operates. 



v>pium, and continued till its effect visible in tfcu 

rth, luis appeared to contribute essentially to die cure. 

In tin- more advanced stages of tin- disease, particularly in 
Southern States and in low unventilated situations, the 

mouth, teeth, and inside of the lips, become covered with a 
brown crust, and the ton^ie becomes so dry and still, that the. 
patient can only make known his wants in whispers, or by signr,. 

Under these circumstances, wine of the best quality, given 
With a liberal hand is the principal resource, aided by the ap- 
plication of blisters to the back and wrists, and mustard poul- 
^ to the feet or ancles. Volatile alkali and camphor are 
also generally employed in such a state of debility ; but wine 
when it can be had of a good quality, is much more to be de- 
pended on. It has been many years the practice in the West 
India Islands, to employ cold water in the cure of the remit- 
tent fever accompanied w r ith bilious evacuations, both inter- 
nally and externally ; when therefore, the disease resists die 
usual remedies, this remedy may be substituted ; in the em- 
ployment of which the following rules should be carefully ob~ 
ed. Cold water may be drank throughout the hot stage of 
the paroxysm not only with safety, but with evident benefit, 
and the more freely in proportion as the heat is farther ad- 
vanced above the usual healthy standard. 

But it is a hazardous remedy after the sweat has flowed for 
some time, as well as in the cold or forming stage of intermit 
rent and remittent fevers, however urgent the thirst. 

Taken at such times as appear from several judiciously con- 
ducted experiments, it increases the chilliness and torpor of 
the surface and extremities, and produces a sense of coldness 
in the stomach, augments the oppression at the praecordia, and 
.vnders the pulse more feeble. The thirst therefore, in the 



46 

cold or forming stage of the paroxysm should be gratified with 
warm liquids. 

"When the hot stage is completely formed, large draughts of 
cold liquids are highly grateful ; they generally diminish the 
heat of the surface several degrees, and they lower the frequen- 
cy of the pulse. "When they are attended with these salutary 
effects, sensible perspiration and sleep commonly follow. 

It may therefore be used with safety, and generally with ad- 
vantage at any time, when there is no sense of chilliness or 
symptoms of an approaching cold stage present, when the heat 
of the surface is steadily above what is usual in health, and 
when there is no general or profuse perspiration. 

In all cases where the pulse is strong, and the heat conside- 
rably above the healthy standard as measured by a suitable 
thermometer, placed under the axilla or within the patient's 
mouth, (the lips being shut to prevent the entrance of the ex- 
ternal air) wiping the whole surface of the body with a linen 
napkin wrung out of cold water, or vinegar and water, has a 
powerful eifect in moderating those symptoms and shortening 
the paroxysm, but in all cases wherein the symptoms of the dis- 
ease resemble those of the typhus, or what in popular language 
is called the nervous putrid, or spotted fever, (the typhus 
mitior and gravior of the schools), sprinkling, or even 
dashing cold water over the naked body of the patient, has 
been found more efficacious in bringing on a safe and speedy 
crisis or solution of the paroxysm, than any other mode of 
treatment.* 

* " Napkins wrung out of cold water, should always be kept applied to 
the head when it is hot, and the vascular action strong. This by reducing 
t-he heat-producing process, abates all the symptoms of the disease." 

£eddoes > Researches, Anatomical and Practical^ 
concerjmig Fever, p. 217—1807. 



W 

i nder this application more certain as well as perfectly 
, the following rules are recommended by the late ingeni* 

Dr. James Currie, of Liverpool. 

i >t. Under these circumstances, the temperature ofthewa- 

ihould not be more than fifteen or twenty degrees lower 
than that of the human body. 

2nd. The patient being taken out of bed and laid naked 
upon a mattress, or upon a sacking bottom, the water is to be 
sprinkled suddenly over his whole body, or if his strength is 
not too much exhausted, three or four gallons should be 
thrown suddenly over him : he is then to be wiped dry with a 
heated napkin, put to bed between blankets, and to take a ta- 
ble spoonfull of wine frequently, mixed with a draught of 
warm barley water, or thin panado, to encourage the flow of 
sensible perspiration. 

3d. This remedy should be applied at the time that the 
exacerbation of the hot stage of the paroxysm is on the in- 
crease, or has come to its height, or immediately after it has 
begun to abate. This remedy appears to be improved by sa- 
turating the water with common salt, 

The affusion of cold water, does not however, procure the 
same advantages w r hen employed in the more advanced periods 
of this fever, as in the earlier stages, (when it is not connected 
with local affection or phlogistic diathesis), when the strength 
is less impaired and the morbid actions less firmly established. 
It is however, evidently advantageous in any stage with the 
exceptions already noted, while the heat of the patient raise? 
the thermometer higher than the healthy standard, though it 
requires more caution in the advanced period of the disease, 
and in such cases the temperature of the water ought never to 



48 

be more than fifteen or twenty degrees below the heat of the 
blood. 

In recommending the affusion of cold water therefore, as a 
remedy in fever, an express exception is made against its use 
both during the cold stage, or durihg the continuance of the 
chill, and after the perspiration has began to flow freely, and 
more especially, after it has continued to flow copiously for 
some time. An exception is also made against its being em- 
ployed in the latter end of fever when the strength is much 
exhausted, and the heat is sometimes as low or lower than the 
usual temperature of health. 

While however, the heat rises one or two degrees above the 
healthy standard, this remedy may be used in any stage of 
fever. But as it is scarcely to be expected, that at an advan- 
ced period of the disease, the progress of the fever can be 
stopped, or its duration much shortened, it may answer the 
same purpose, only in a degree somewhat less, in such cases, 
to employ the tepid affusion. 

The term tepid, is applied to water when heated to that de- 
gree which is warm, but not hot to the sensation, and which 
in the way of affusion, is from 87° to 90° of the scale of 
Fahrenheit. 

By the sudden affusion of tepid water, the heat of the li- 
ving body is in many cases lowered as speedily as by the affu- 
sion of water that is cold. It very generally produces a 
considerable diminution of heat, a diminished frequency of 
the pulse and respiration, and a tendency to repose and sleep. 
It may therefore be substituted with propriety by those who 
dread the shock given by the sudden application of the cold 
affusion, and especially by those whose debility might render 






the application of the lattei kazaido IS. — Whet) situation or 
other circumstances, render the dashing of kepi upon 

the bod] very inconvenient, the febrile heat may be conside- 
rably reduced* and the frequency <>( the pulse diminished by 
moistening the palms of the hands and die soles of the feel 
with Vinegar; for it appears to be from the sensation of heat 
in th< nities that the stimulus to the ..ystem is chiefly 

derived. This is uniformly a safe, as well as refreshing 

dy.* 

When none of the applications recommended are complied 
with, benefit may be afforded, though in an inferior degree,, 
by spunging or wetting the body and limbs with cold or warm 
vinegar and water, especially when the symptoms indicate 
considerable vigour in the arterial system. This application 
like the others, should be regulated by the actual state of the 
patient's heat and sensations. But this mode of cooling the 
patient is not only less effectual, but in many cases less safe ; 
for the system will often bear the sudden and general shock 
occasioned by the cold or warm affusion, when it sinks and 
fails from reacting under the more slow and successive appli 



* Mr. Theden, third Prussian surgeon-general, states, that in a malignant 
fever when the pulse was sinking- and death so to speak, sat upon the tongue, 
he had applied compresses wetted with cold watar upon the abdomen and 
scrotum, washed the breast, arms, feet and face with it, dried the parts 
and covered the patient with blankets, after which, warm liquids with a 
glass of wine, and a cordial draught with volatile alkali, were administered 
from time to time. — A full pulse succeeded, afterwards sweat, and the pa- 
tient was recruited. In this way, he says he has saved numbers. Many 
who in such desperate circumstances employed all the means except the 
cold application died, whereas most of those recovered who used that also. 
Mr. Theden adds, that on applying the cold compress to the abdomen and 
scrotum, the patient shrinks, shudders, and becomes as it were reanimated- 
Now cordials have effect, and busters, before inactive, draw." 

B-ddoci /iesearches—p. 219 



50 

cation. It appears therefore, that the cold affusion is most 
effectual and best suited to the earlier stages of fever, un- 
combined with local affection or phlogistic diathesis ; and 
warm affusion in the latter stages, and in cases of considerable 
debility. 

The term cool, is applied to a temperature from 78 to 75° y 
when water of this temperature is employed the application 
should be sudden and momentary, by which a reaction of the 
arterial system is generally the consequence, and frequently a 
complete solution of the fever. 

Throughout the whole of Dr. James Currie's reports, it is 
frequently urged and repeated, that " the solution of fever 
depends chiefly on the sudden, general, and powerful impres- 
sion which is made on the sensations by the affusion ; where- 
as, ablution only serves to alleviate symptoms, and to render 
the disease milder and the crisis favourable. 

Dr. Jackson supposes the cold affusion excites new actions 
which supercede the former ones, and by that means cuts 
short the progress of the fever. 

Opium has been employed of late years, by many physi- 
cians, in doses of one or two grains at a time, in the latter 
stages of the remittent fever, as well as in typhus, or continued 
fevers unconnected with inflammatory affections or preter- 
natural arterial power, for the purpose of procuring sleep and 
inducing more perfect remissions ; but recent experience 
proves that this method of administering opium, is by no 
means so efficacious as when it is given towards morning, or 
a short time after the exacerbation of the hot stage has begun 
to decline. When given during the increase of the exacerba- 
tion, it increases the heat and restlessness. 



OF THE SYXOCin s ICTERODES. 

ok, 

MALIGNANT YELLOW FEVER 



Although the malignant or pestilential fever, com- 
nonlv called the yellow fever, like the small-pox and measles, 
is of foreign origin, and of a contagious nature ; and has 
11 produced by any cause or combination of circum- 
stances in this climate, as the facts which have been published 
bv the college of physicians of Philadelphia, as well as my 
own observations, have fully satisfied me ; yet as it has been 
my lot to witness the repeated occurrence of this formidable 
and frequently fatal disease of late years, it may not be im- 
proper in this place, for the satisfaction of those who have 
not had the same opportunities, to exhibit a concise view of 
its most usual symptoms, with an account of the method of 
treating it, which I have observed to be most successful in 
my own practice, as well as in the practice of others. 

In this disease there is a very great diversity of symptoms, 
according to the particular constitutions of the patients, and 
other circumstances, similar to what occurs in the small pox, 
and other contagious diseases. In some the symptoms being 
mild and favourable ; in others, the pulse strong and quick, 



52 

and the heat great and distressing ; while in others, it com- 
niences with great debility, oppression and restlessness. 

In general it attacks suddenly, without any previous indis- 
position, with a chill, and pain in the head and limbs ; some- 
times, but not always, with sickness at stomach, and an incli- 
nation to vomit — the eyes also appear inflamed and are pain- 
ful — the pulse frequently becomes full and quick soon after 
the cessation of the chill, (which is generally of short dura- 
tion) but without much apparent disorder in the respiration ; 
the skin soon becomes very hot and dry, and the face flushed, 
as well as the eyes red and watery; great oppression and 
stricture about the praecordia, accompanied with extraordinary 
restlessness and frequent sighing.— The heat of the skin, and 
pain in the head and limbs, generally continue to increase 
during the first thirty-six hours, and then to decrease gradu- 
ally for the same length of time ; so that at the end of seventy- 
two hours, all febrile heat and fulness of the pulse, together 
with the pain of the head and limbs, either leave the patient 
entirely and he speedily recovers, or they only remit partially, 
and are in a few hours succeeded by a different and more dis- 
tressing train of symptoms ; and particularly by a painful 
burning sensation in the stomach, accompanied with almost 
constant sickness, and straining to vomit ; the contents thrown 
up at this period of the disease, are generally of the consis- 
tence of thin mucilage and of a cerulean or sea green colour 
—the pulse now becomes small, quick and irregular, the sto- 
mach painful upon pressure, and the costiveness of the bow- 
els generally continues, but in some attended with tenesmus 
and griping.-— These symptoms continue to increase in sever 
nt}', if not soon relieved by art, and are in a short time suc- 
ceeded by a sudden cessation of pain and heat, and a vomitr 
jng of a flaky, dark coloured mixture, resembling coffee 
grounds or the sediment of port wine, and in soms cases. 



Kturc of soot and water. — Tin iall\ 

wn up at abort intervals, mixed with a greater quantity 

of liquid than has been drank. 

In this stage of the disease, during the intervals from vo- 
miting, the patient feels so much ease that he imagines him 

to he out of danger ; converses fluently, though somewhat 
incohercntlv, on various subjects. — Some under these cir- 
cumstances, rise out of bed, walk ahout the chamber, but 
soon becoming faint and exhausted, lie down again. Con- 
vulsions or lethargy, generally follow these exertions, and 
death soon after closes the scene. Many however, instead ot 

g affected with the black vomit, become comatose, and die 
without a struggle ; while others sink under the loss of blood 
from the nose and mouth, and sometimes from the eyes and 

, or from the bowels, as well as from the parts where 
rs have been applied. 

In most of the cases in Philadelphia, that have terminated 
mortallv, the patients became as yellow as gold, before the 
vomiting of black matter made its appearance ; the whites of 
the eyes which at the beginning of the disease, were red and 
watery, became of a dull muddy yellow — the yellowness was 
first observable in the eyes, face, temples, and neck, and soon 
after over the whole body — In the first stage of the disease, the 
tongue was generally covered with a white fur ; its upper sur- 
face appearing as if it was covered with a piece of white mus- 
lin. After the third or fourth day, when the fever continued, 
it became brown and much drier ; but after the appearance 
-t the black vomiting, it again became moist, and nearly as, 
< lean as in health. 

The patient seldom vomited after the chill went off, during 
*he first and second days of the disease, though he usually 



54 

complained of a load and an inclination to vomit — and he was 
either costive or affected with symptoms of dysentery, owing 
as appears from dissections, to an inflammation of the sur- 
face of the stomach and duodenum, and other portions of 
the intestines. Bile was rarely observed in the stools at an 
early period of the disease, unless when occasioned by means 
of purgatives ; but when it did occur, it afforded a favourable 
prognostic. Black stools were common after the commence- 
ment of the black vomiting, and sometimes appeared of a 
dark colour after the exhibition of calomel, without being 
accompanied with black vomiting; but in those cases the 
evacuation was of a different consistence. AVhen this disease, 
(which was generally more violent in its symptoms, more 
rapid in its progress, and more mortal in the event, than any 
other disease that has ever been observed in this country), 
was protracted more than a week ; tremors of the hands 
sometimes occurred, but subsultus tendinum was scarcely- 
observed in any case of this fever, though so common in the 
typhus, and in the last stage of bilious remittents. 

When the disease ended favourably, the violence of the 
symptoms generally subsided on the third, fifth, or seventh 
day ; and when it terminated fatally, the symptoms became 
more distressing and severe on the days last mentioned, and 
the patient died on the fourth, sixth, or eighth day from its 
commencement, most generally on the sixth or eighth, though 
a few have lingered to the eighteenth or twentieth, and some 
still longer, and died at last. 
c 

In persons of infirm constitutions or that lived abstemi- 
ously, symptoms of nervous affection were more prevalent 
than those of an inflammatory character. — In such persons 
the pulse was seldom strong or the heat very great, and the 
fever was longer before it came to a crisis. In persons whose 



55 

titutions had been impaired b) habitual intemperance^ 
well us in those who had b ■;!>• debilitated bj e^traor- 

dina! ic, or violent exertions, putrid and malignant 

s\ mptoma appeared carl) in the disease, and in its latter Stage, 

constant hemorrhages from the nose, mouth and tongue* — 

Sexual hemorrhages were also frequently profuse, and 
abortions common in pregnant women. In numerous cases, 
extravasated blood appeared under the cuticle, and large 
purple spot, on different parts of the surface of the body; 
and in almost every ease that terminated fatally, the skin 
ne of a deep yellow, or orange colour, mixed with a livid 
or purple colour, and the gums became spongy and scorbutic. 
Persons with those symptoms seldom survived the sixth day, 
and some died as early as the fourth. 

Tn the latter stage many were affected with coma and 
haemorrhages, and great yellowness of the skin and eyes, and 
died without any symptoms of black vomiting. * 

In all the cases affected with the black vomit, the pulse 
became slower than in time of health — in many instances not 
beating more than forty or fifty times in a minute — and was 
generally accompanied with a bloated appearance of the fate 
and a remarkable coldness of the face and limbs. Suppression 
of urine in the latter stages of the fever, frequently occurred, 
and like the black vomiting, almost invariably indicated a fatal 
event.* 

* In these cases there appeared to be a total suspension of the office of 
the kidneys, for there was no urine found in the bladder, nor any inclination 
to evacuate it. 

Whenever this symptom occurred and was not produced by the irritation 
or absorption of cantharides, it indicated speedy dissolution, especially when 
conjoined with singultus and the vomiting of a dark coloured mixture, re- 
sembling coffee grounds, or dark coloured mucous filaments, and especially 
when accompanied with a preternatural slowness of the pulse. When ah 
these symptoms occur, they are very soon followed b> coma and ina< 
lity, or by convulsions, swooning, and death 



56 

The symptoms which distinguish this fever from cvciy 
other that has been observed in this country, are the sudden- 
ness of the attack, commencing in most cases, without any pre- 
ceding lassitude or indisposition ; the redness of the eyes and 
flushing of the face ; and the long duration of the paroxysm be- 
fore a remission takes place, being generally thirty-six hours 
before any considerable abatement is observable in the febrile 
symptoms; whereas in the indigenous remittent or bilious fever, 
the violence of the paroxysm invariably remits within the first 
twenty-four hours ; and the paroxysm of the latter is re- 
newed some hours after the first remission, which is seldom 
observed in the yellow fever ; but on the contrary, in almost 
every case where the fever has been violent, and the painful 
sensation of the stomach considerable, it is succeeded by a 
new train of symptoms, in a few hours after the remission of 
the fever ; particularly by frequent retchings, and vomiting of 
matter, which for a day or two, appears of the consistence of 
thin mucilage, and of a sea green or light olive colour, but 
afterwards becoming darker and mixed with flaky filaments, 
or membranous like fragments, at first resembling coffee 
grounds, and afterwards becoming darker and appearing like 
a mixture of soot and water, which is evacuated at short in- 
tervals, and in an extraordinary quantity. The yellow colour 
of the skin and eyes, is common to both the bilious and the 
yellow fever in persons of a plethoric habit, but is generally 
much deeper in the yellow fever. 

The remarkable retrocession of the high and inflammatory 
symptoms which in the most dangerous cases of the yellow 
fever generally takes place about the third or fourth day, and 
leads the inexperienced observer and the deceived patient to 
conceive hopes of recovery, when there is no greater indica- 
tion of his speedy dissolution, is a circumstance without a 
parallel in the history of fevers, and therefore in dangerous 
cases, may be considered a pathognomonic sign of this disease. 



The Other symptoms which more particularly distinguish 
this fever from every other that has ever come under my 
not'u t mortal cases of are the blackness and 

flaky or curdly appearance of the matter thrown up hy vo- 
miting, and the preternatural slowness of the pulse which 
occurs after the vomiting of black matter has commenced. 

Tlie circumstance of its being communicated by contagion 
in confined situations, also distinguishes it from every form 
or variety of the bilious remittent of this climate; and for 
proofs that it is communicated from one to another, I refer 
to the publications of the college of physicians already men- 
tioned. 

Dr. Hume, commissioner of the sick and wounded of the 
British navy, in the West Indies, in the years 1 741 and 1 742, 
asserts, that in all the subjects that he had opened himself or 
seen opened by others, after having had black vomiting, the 
stomach was always found mollified, and less or more of 
such fluid as they had vomited was found in the cavity of it, 
and could easily be pressed from the vessels. — In two of his 
dissections, of persons who had died before the third day, he 
found the inner coat of the stomach highly inflamed, but no 
marks of gangrene. — In two others who died at a later period 
in the year 1735, at Barbadoes, who had had black vomiting, 
he found the villous coat mortified in several places — (pages 
208 and 217, of his account of the yellow fever.) — That mor- 
tification of the internal membrane of the stomach always 
precedes or accompanies black vomiting, I am convinced 
from the numerous dissections which have been made by dif- 
ferent practitioners since the publication of Dr. Hume. 

" The liver which is naturally of a dark red colour, fre- 
quently appears on dissection, in the yellow fever to be pale 
and yellow." 

8 



58 

u Further down the intestines the black stuff was thicker 
and more viscid, almost resembling tar.-— In those cases the 
villous coat was very easily separated by drawing the fingers 
over it."< — •ffwne's account* 

In the year 1805, the last time of its appearance in Phila- 
delphia, I was several times present at the examination of the 
stomachs of patients who died of the yellow fever at the City 
Hospital, but could discover no certain marks of gangrene in 
any of them, though the villous coat was generally abraded in 
different parts, and the excoriated parts appeared of a very- 
dark colour — -extravasations of blood were also common ; and 
yet, the sudden cessation of pain in that organ succeeded by 
cadaverous coldness of the limbs and slowness of the pulse, 
afforded a strong presumption that the inflammation in that 
organ had ended in gangrene, or partial death of the villous 
membrane. 

The black matter usually found in the stomachs of those 
who died after the fourth day had none of the characters of 
either blood or bile; for white paper immersed in it was 
neither stained red, purple, yellow or green, but appeared 
like it does when moistened with the fluid which issues from 
a gangrene ; yet, from the extravasated blood, which always 
appeared on different parts of the internal surface of the sto- 
machs of those who had had the black vomit, and the exten- 
sive and florid inflammation observable in the stomachs of 
some who died at an early period of the disease, and had not 
vomited any black matter, though the vomiting of every thing- 
received into the stomach had been almost incessant, I am 
inclined to believe that the black coloured matter resembling 
coffee grounds, (and which is generally known to be the sig- 
nal of a fatal termination), is chiefly composed of small por- 
tions of common mucus, coloured by the. dissolved and black 



59 

blood which oozes into h from the- dilated capillaries. It can- 
not be bile, changed in its colour, in consequence of a morbid 

e of the secretor) i the liver, because those vt 

scU i dom found diseased, and because the bile in the 

gall bladder, which was generally lull, retained its natural 
yellow colour, or was changed to the colour and consist 
ot the s\ run of rhubarb, or a mixture of gamboge and mu- 
cilage. 

Nor is it probable, that the matter, which resembles coffee- 
grounds, is bile, changed in its colour and consistence after its 
entrance into the stomach, because large quantities of such 
matter was found in the stomachs of several who had had 
little or no vomiting of any kind ; and without some vomiting, 
or at least some exertions to vomit, bile cannot gain admission 
into the stomach. Nor can the dark coloured flaky parti - 
tides, which give the appearance of coffee grounds to the 
contents of the stomach, be the villous coat detached or abra- 
ded, because neither ulceration or gangrene were observable 
in the stomachs of some that had vomited black matter, and 
without ulceration or gangrene it cannot be abraded. 



CONJECTURES 

Relative to the Origin of the Yellow Malignant 
Fever.. ..with Facts and Arguments subversive op 
the Opinion of those who ascribe it to Domestic 
Causes. 

From the frequent opportunities which I have had of see- 
ing the rise and progress of this malignant disease in Phila- 
delphia, and from the facts which I have received from Dr. 



60 

Hosack of New York, a professor and physician of the first 
eminence in his profession, as well as from several other phy- 
sicians of established character in other cities and sea-port 
towns of these States, who have had similar opportunities, 
and who regard the cause of truth more than the convenience 
of those " who drive the car of trade." I am convinced that 
it is a contagious disease, and that every time it has appeared 
in this country, the contagion by which it is propagated has been 
imported from some of the West India Islands, in the persons 
of the sick, or in articles of clothing, or bedding, that have 
been used by the sick ; but from what cause the contagion 
proceeds, or is originally produced, t do not pretend to know 
with absolute certainty; though, I am inclined to believe, 
from the facts which have been recorded by different authors, 
particularly by the Jesuit Pere Labat, Drs. Des Portes — 
Dalzille — the Revel. G. Hughes — Don Ulloa— Dr. Rouppe 
*— Dr. Schotte, and more recently by Dr. Chishohn, that the 
contagion of this disease is only generated on board of foul 
and crowded transports, or ships of war, after long confine- 
ment in hot climates ; and that it is produced by the joint ope- 
ration of the exhalations from living human bodies in an im- 
paired state of health; and the exhalations from the corrupted 
bilge water confined in the ship's hold and well, particularly 
during the rainy season, when from the necessity of keeping 
the hatches shut, fresh air is in a great measure excluded, 
cleanliness neglected, and the noxious exhalations permitted 
to accumulate. — The disease has never been known to make 
its first appearance on shore in tropical climates, owing, I 
presume, to the want of a concurrence of all the circumstances 
which sometimes occur on ship-board. 

It is a fact generally admitted, that the effluvia from a 
number of human bodies in confined and unventilated situa- 
tions, generally produce a disorder in the different functions 






.1 ti i exhalations, for aiq 

ill of time ; and that in persons tl 
noxious substance 1 Becreted which is capable of propagating 

the d the sick to the sound; hence, a strong pre- 

sumption >ntaglOU8 principle which gives ori- 

gin to the yellow lever, is generated by a specific process ol 
secretion in the human body, in consecmence of the combined 
operation of the exhalations from the living human body, and 
of the gases, which proceed from the putrid vegetable and ani 
lubetancea contained in bilge water. 

The most satisfactory proofs that the malignant yellow 
fever is a distinct disease from the indigenous remittent, or 
bilious fever of the Southern States of America, as well as 
from the typhus gravior, were communicated to Dr. Hosack 
in the year 1805, by Dr. Joseph Bayley, one of the physicians 
on the Quarantine station, a copy of which was published 
soon after the last time that the disease appeared in Philadel- 
phia and New York, which was in the year 1805, by the College 
of Physicians of Philadelphia, in a pamphlet, entitled " Addi- 
tional Facts and Observations relative to the Nature and 
Origin of the Pestilential Fever." 

The causes assigned for the origin and generation of the 
malignant fever commonly called the yellow fever, by those, 
who trust to theory, in preference to the testimony of their 
own senses, are, the noxious exhalations which proceed from 
the filth of cities, comprehending the common sewers and 
covered drains, gutters of the streets, docks, privies, neglected 
ars, yards, burial grounds, and the impure water of the 
pump wells, &c. 

But if it can be made appear that the pestilential fever, 
usually called the yellow fever, occurred with all its compli 



62 

cated horrors in some of the commercial cities or sea-port 
towns of this country at an early period after their first settle- 
ment, when none, or but few of the causes existed to which 
the origin of die disease has been imputed by the advocates of 
its domestic origin ; and, if it can also be shewn that this pes- 
tilential disease did not make its appearance for many years 
previously to the year 1793, in any of those commercial cities 
or seaport towns, though the enumerated causes existed in 
much greater abundance during that period than they did at 
an earlier period, or than they have existed since the year 
1793 ; we are most egregriously deceived if it may not be fairly 
and satisfactorily concluded, that it does not originate from 
those sources. 

In tracing the malignant yellow fever to its earliest occur- 
rence in this country, we find from the Journal of Thomas 
Story, Esq. Recorder of the city of Philadelphia, vol. 1st, that 
a very mortal fever prevailed in Philadelphia, in the autumnal 
months of 1 699, which carried off six or eight persons daily, 
and some days ten or twelve. Mr. John Gough in his ac- 
count of this fever, in his History of the Friends, vol. 3d, p. 
516, says, that the fever which occurred in Philadelphia in the 
year 1699, was the same as that which has since been called 
the yellow fever, and had been prevalent for some time before 
in several of the West-India islands. This fact is also con- 
firmed by a letter written by Isaac Norris, Esq. who resided 
in Philadelphia during its prevalence, who also relates that it 
was very mortal in Charleston at the same time. It also ap- 
pears from an extract from Hewatt's History of South Caro- 
lina, communicated by Dr. Tucker Harris, that a great 
number of the inhabitants of Charleston were destroyed by 
it in 1 699, that they suffered very much from a hurricane the 
same year, and that the greatest part of the town was laid in 
ashes by fire. 



rds of the occurrence of this disea 
York, in the year 1699 j but tin- lite Dr. John Ban 
mentions in a letter, a copy of which was published in Car* 
Museum for the year LJT88, page 453, that he had heard from 

the ancient inhabitants of that city, that SO long ago as the 
I malignant lever little interior to a plague w a 
imported into it, which from its extreme mortality was distin- 
guished bv the name of the great sickness. This event is alflO 

rded bv Mr. Story in the 2d volume of his Journal. Ac 
cording to Mr. Hewatt's history, the yellow fever made its 

nd appearance in Charleston in the year 1703, at which 
time the inhabitants were apprehensive of an invasion from 
the French and Spaniards. It appears from Hutchinson's 
history of New-England, that a similar fever was imported 
into Boston in the year 1693, from Martinique, by the fleet. 
Sir Francis Wheeler: see Hutchinson's history, vol. 2, p. 
72. At the time of its first appearance in Philadelphia 
and Charleston, it was, and had been for several years 
-prevalent in several of the West-India islands, into which 
it had been imported in the year 1686, from Siam in the. 
East-Indies, by a fleet crowded with passengers and dis- 
appointed adventurers from that kingdom, according to the 
testimony of Labat, a Catholic missionary, who was sent from 
France to Martinique in the year 1 694, to take charge of the 
churches there, which was eight years after that distressing- 
occurrence. 

It is also stated by Dr. Pouppe Desportes, who practised 
physic in St. Domingo from 1732 to 1748, in his observations 
on the diseases of that island, that the yellow fever, which he 
calls the " putrid malignant fever," was for a long time un- 
known in the islands, and that the first event which rendered 
it remarkable, was its appearance at Martinique soon after 
the arrival of a fleet from Siam. The regularitv of its repro- 



64 

duction, however, at particular seasons of the year, he thinks, 
se^ms to require that it should be classed among the indige- 
nous diseases of tropical climates. 

Sauvages takes notice of this disease, in the first volume of 
his Nosology, p. 557 y and says it was imported into Marti- 
nique in the year 1686, from Siam, by a ship called the Ori- 
fla e. A similar belief is expressed by Dr. Chevalier, as 
quoted by Dr. Lind. M. de St. Mery, in his history of the 
French part of St. Domingo, delivers a similar opinion with 
respect to the origin of the yellow fever in the West-India 
islands, and relates some additional facts respecting its spread- 
ing to several of the other islands ; for the particulars of 
which, the reader is referred to the history of the French part 
of St. Domingo (in French) p. 700. After the year 1703 
there is no record or popular tradition that I can learn of the 
appearance of the yellow fever in any part of the continent of 
North America for twenty-five years, though it continued its 
ravages in the islands for many years after that period, as we 
learn from Mr. Hughes' Natural History of Barbadoes, and 
from Warren's and Hillary's publications, as well as from 
Moreau de St. Mery's History of St. Domingo. 

Mr. Hewatt, in the history already quoted, relates that in 
the year 1728, after an uncommonly hot and dry summer, a 
dreadful hurricane occurred in the month of August, and the 
same year an infectious and pestilential distemper, called " the 
yellow fever," swept off multitudes of the inhabitants, both 
white and black. Mr. Hewatt also mentions the occurrence 
of the same disease, in the years 1739 and 1740. Dr. Harris 
says there is no medical record of the existence of the 
yellow fever at Charleston previous to the account sent 
by Dr. John Lining of Charleston, to Dr. R. Whytt of 
Edinburgh, from which it appears that it was prevalent in 



that city in tl. , 1JT39, 171.*, and 1 748 . and in the 

opinion of Dr. Lining, it u;is an imported d3 ad coma 

jr'ious. I understand that yon have BOmc additional facts on 

this subject, pr es erv e d in tin- Manuscript notes of J)r. I' 

lean. Dr. Hai ris states that he knows of no documents of the 
existence of the yellow fever in Charleston from the j 

17-4 8, to the year 1792; I presume lie means 1794; though 
he recollects that it made its appearance there in the yeai 
1761, and proved fatal to some strangers, and to one-person 
who, he had been told, had long resided there. 

At the time the yellow fever prevailed in Philadelphia and 
Charleston in 1699, and for several years after that period, 
the population was very inconsiderable, the buildings scattered, 
and many of them unconnected ; consequently, but little of the 
filth and puU*efaction, common to populous cities, could have 
existed in them at that time. There were no common sewers 
or covered drains, and but very few docks or wharves. The 
privies were not numerous ; the water of the pump wells cer- 
tainly was as pure as at present, nor were the grave yards 
numerous or crowded with dead bodies. Consequently but 
few of the causes assigned by the supporters of the doctrine 
of the domestic origin of the yellow fever had " a local habita- 
tion or a name," at least to any considerable extent, and yet 
the disease did make its appearance and spread with resistless 
fury, not only in Charleston, but in Philadelphia and New- 
York, From the year 1703, there was an interval of twenty- 
five years before its next appearance at Charleston, and up- 
wards of forty years between the first and second time of its 
appearance at Philadelphia or New-York. It afterwards 
occurred in Philadelphia in the years 1741, 1747, and. 1762, 
and at New- York in 1 748, after which it was no more heard 
of in this country till the year 1793, when it made its tri- 
umphal entry into Philadelphia, and marked its way with 

9 



66 

dreadful mortality. Charleston escaped its invasion till the 
year following ; and New-York a year later, since which time 
the frequency of its occurrence and the deplorable mortality 
occasioned by it are too strongly impressed upon the memory 
of those who have survived, to need particularizing. Having 
now shewn, that the pestilential yellow fever made its appear- 
ance in this country at a period when there existed none, or 
but very few of the sources to which its origin is ascribed by 
those who believe it to be derived from domestic causes, let 
us in the next place take a view of subsequent periods, when 
filth and all the enumerated causes of its generation had gready 
increased, and had become offensive to the senses ; and we 
shall find that no such disease was the consequence. 

In the years 177/, 1778, and 1779, the city of New-Yorlc, 
and the city of Philadelphia in the year 1778, were in posses- 
sion of a large army of British and Hessian soldiers, and in 
the years 1780, 1, and 2, Charleston was also in possession of 
an army of nearly six thousand foreigners. During those 
periods less than usual attention was paid to cleanliness, as 
the minds of the inhabitants were kept in a constant state of 
alarm and uncertainty : hence putrefying animal and vegeta- 
ble substances were suffered to accumulate and contaminate 
the air with their noxious exhalations ; yet not a case of yellow 
fever occurred in either of those cities among the natives or 
foreigners. It is true, a great mortality occurred among the 
American prisoners that were confined on board the memora- 
ble Jersey prison ship, stationed in the harbour of New- York, 
during the hot season, with symptoms of great putridity, and 
the disease was contagious ; but not a case with the diagnostic 
symptoms of yellow fever made its appearance either among 
those confined on board, or among the inhabitants of that city. 
The American prisoners, many of them from the northern 
states, v/e/e conveyed from crowded prison ships to hospitals 



in the city of Charleston, yet not a smgl yellow I 

• red. 

lit time th( . \wrs, gutters, 

privies, and a variety of other sources of putrefaction in each 
of the utics which have been mentioned as well a /era! 

9 alter that period ; and cleanliness was much Less attended 
to by the police from that time tothe year 179.3, than it has 
been since ; yet no yellow fe*er spread destruction and deso- 
lation through the streets of tlio^c cities, during that interval, 
as it has clone since the period last mentioned. 

We have now shewn, that the yellow fever made its ap- 
pearance in the cities of Philadelphia and Charleston at an 
early period of their infancy, when but very few of the causes 
which are supposed by those who pretend that it originates 
from the confined and impure air of populous towns existed. 
AYe have also 6hewn that for a long period after those cities 
had become populous, and the sources of putrefaction had 
multiplied, and particularly, that during those years that the 
British and Hessian forces had possession of those cities, at 
u'hich time the enumerated domestic sources which have been 
so confidently pronounced to be the cause of its origin, existed 
with aggravated circumstances, no yellow fever made its ap- 
pearance or was the consequence. 

If to these facts we add the well-known circumstance of the 
escape in 1793 of every seaport and commercial town in the 
union, with the exception of Philadelphia, and recollect that it 
had made considerable progress, and had occasioned very ex- 
traordinary mortality in several of the West-India islands, and 
particularly in Grenada, St. Vincent, and Dominica, several 
months before it made its appearance in Philadelphia, and that 
n it did make its appearance, it was distinguished by an 



68 

assemblage of symptoms which had never been observed 
m any disease that had occurred in Philadelphia since the 
year 1762, and in that year, according to the notes of 
Dr. Redman, late president of the College of Physicians of 
Philadelphia, it was imported from Havanna, and communi- 
cated by a seaman to the family with whom he lodged in 
Jackson's Court, near the New-Market ; if we recollect that 
the disease was new to all the physicians that had commenced 
practice in Philadelphia since the year 1762, and that Drs. 
Ross and Stephens, who at that time resided in Philadelphia, 
(the former of whom had lived and practised medicine many, 
years in the East Indies, and had suffered by a fever, attended 
with very violent and dangerous symptoms at Bassorah, on 
the Euphrates, in the year 1781, and the latter had been in 
constant and extensive practice for many years in St* Croix, 
m the West-Indies) had never seen a fever with the particu- 
lar and extraordinary symptoms by which that disease which 
prevailed in Philadelphia in the summer and autumnal months 
of the year 1 793, was distinguished ; and if we bear in mind 
that this destructive malady prevailed in New-Haven in Con- 
necticut, Baltimore in Maryland, and Charleston in South- 
Carolina, in the year 1 794, while all the intermediate seaports 
escaped; and that in 1798, Easton in Maryland, Baltimore, 
including Fell's Point, Charleston and Savannah, (places 
noted for the insalubrity of their atmosphere in the autumnal 
season) escaped; while Boston, New-London, New- York, 
Philadelphia, and almost every other commercial town, and 
several of the villages on the navigable rivers in the eastern 
and middle states were sinking under its resistless fury; it 
appears a matter of astonishment, that any person of sound 
understanding can hesitate in deciding, whether it is of foreigr 
or domestic origin. 



09 

lo extricate themselves from the dilemma to wli'n h they 
have been reduced bj facts and arguments similar to the pre- 
ceding, same of th< leading and most influential of the advo- 

cates ot the doctrine of domestic origin of yellow lever, have 
had recourse to the power of imagination, and I con- 

tagion as a vulgar error, have revived and adopted the more 
vulgar and exploded doctrine ot" planetary, comctic, and vol- 
tank influence upon the constitution of the atmosphere ex- 
tended round the spacious globe ; and have dogmatically pro- 
nounced, without offering any but the most puerile and 
frivolous evidences in support of their opinion, that a noxious 
and impure change has taken place in the proportion of the 
constituent principles of the atmosphere ; a doctrine, which is 
so foreign from correct observation, and so destitute of proof, 
that its adoption could only be excusable in the dark age ol 
Gothic barbarism, when die human mind, unenlightened by 
liberal education, and paralized by the fears of superstition 
and the arts of impostors, rose in intellect but a small degree 
above brutal instinct. In short, to ascribe the occurrence of 
the yellow fever in Philadelphia, after an exemption of thirty- 
one years, to a noxious and invisible change in the constitution 
of the atmosphere, without furnishing direct and unequivocal 
proofs that such change has taken place, is one of the tricks 
of ingenuity to impose upon and mislead unreflecting credu- 
lity, and is no more worthy of credit or respect than the 
Arabian Nights Entertainments, or than the conceits of the 
astrologers and conjurers in the ages previous to the revival 
of literature, when every disease as well as every natural 
phenomenon not obvious to the senses, was ascribed to the 
influence of the planets. In point of absurdity and folly it is 
a match for the story related by Monsieur Poqueville, of the 
ignorant and credulous (i reeks of the present age, who, he 
that a decrepid spectre to which they have given 
the name of Cacodsmon, always precedes the plague, dressed 



70 

in a funeral shroud, and glides along the roofs of the houses, 
calling the names of those who are destined to be cut off from 
the number of the living, while dogs howl hideously respon- 
sive to solemn music and murmuring voices which they arc 
supposed to hear in the air. 

If this puerile and superstitious notion of the modern 
Greeks is rejected with contempt by all men of cultivated 
understandings, because it does not correspond with the ex- 
perience of observers qualified to discern realities from the 
delusions of the imagination; the doctrine of a noxious or 
pestilential change having been produced in the constitution 
of the atmosphere, being the mere creature of the imagina- 
tion, and unsupported by adequate and satisfactory evidence, 
ought to be rejected for the same reason. 

If such a revolution had taken place in the constitution of 
the atmosphere as is pretended, it would be unreasonable to 
suppose it would have operated in such an irregular and 
capricious manner as has been the case, if the yellow fever 
was the consequence or production of such a change, because 
it is contrary to the common course of things. 

If such an extraordinary and unsalutary change had taken 
place, its operation would have been regular and uniform, and 
its influence would have extended to every place upon the 
globe under similar circumstances, and its presence would 
have been manifest from the change it would necessarily have 
produced on every other species of disease that owes its ori- 
gin to the particular condition or qualities of the atmosphere, 
as well as to fevers ; but no such change is observable in cases 
of the quinz'y, pleurisy, small-pox or measles, that have 
occurred since that change in the atmosphere has been said 
q have taken place. If a pestilential constitution of the 



7\ 

a tmo ed, all our seaport, would have s\n : 

tin same time everj year, and not one in the centre ol tin 

union this year, oik- in the northern extremity, and oik- or two 

in the southern extremity the next, and others in a differ 
tion the year after, as well as in other places in an fa 
gular manner several times since, while adjacent and inter 

mediate ones remained entirely exempt, as we know from 
our own observations, as well as from the information of 
others, has been the ease. And as no change has taken place 
in other diseases, as is pretended to have occurred in the fe- 
which appear periodically in cities, though no such change 
is apparent in those in marshy situations in this country, or i 
any other form or variety of disease, as has been satisfactorily 
shewn by Dr. Stringham, of New-York, in a paper relative 
to this subject, published in the first volume of the Edinburgh 
Medical and Surgical Journal, and as I know from my own 
observations, as well as from letters which I have received 
on this subject from Dr. Gardiner of Darby, only seven 
miles distant from Philadelphia, and from Dr. Martin c 
Easton, an insalubrious part of Maryland, it may be fairly 
concluded that no such change has taken place in the constitu 
tution of the atmosphere. 

During the prevalence of the yellow fever in Philadelphia 
in the year 1 793, more than two hundred persons were con- 
fined in the prison appropriated for criminals, exclusive of 
one hundred and six French soldiers confined there by order 
of the French consul, and a considerable number of debtors 
in an adjoining prison. The Pennsylvania hospital contained 
its usual number of patients at the same time. There were 
more than four hundred paupers in the alms-house, and more 
than two thousand emigrants, recently arrived from the island 
of St. Domingo, were at the same time dispersed over differ- 
ent parts of the city and suburbs. All the prisoners in the 



n 

jail, the patients in the hospital, the paupers in the alms-house, 
and the emigrants from St. Domingo dispersed over different 
parts of the city, almost to a man, escaped the disease, though 
they were surrounded by the sick, the dying and the dead for 
several weeks, and breathed the same air as the rest of the 
inhabitants, with the exception of that confined in the apart- 
ments of the sick. 

Circumstances like these establish the fact more forcibly 
than a whole volume of arguments, that the disease was not 
an epidemic, or derived from any general cause existing in 
the atmosphere, or from any derangement or alteration in the 
quality or proportion of its constituent principles, but was 
propagated by contagion alone, otherwise the persons cir- 
cumstanced as just mentioned could not possibly have esca- 
ped more than the rest of the inhabitants ; but on the contrary, 
the emigrants frnm St,. Domingo, not accustomed to this 
climate, would have been the first to experience its effects, and 
would have suffered much more severely from the impurity 
of the atmosphere, if that had been the cause of the disease, 
than the native inhabitants ; for it is a fact confirmed by long 
and extensive experience, and which admits of no exception, 
that strangers are the greatest and most certain sufferers 
from exposure to the causes of the indigenous diseases of the 
climate into which they migrate. But a contagoius fever is 
communicated only from the sick, or articles contaminated by 
them. No sick persons were admitted into the prison, the 
Pennsylvania hospital, or the almshouse, during the preva- 
lence of the yellow fever ; and the emigrants from St. Do- 
mingo, having arrived at Philadelphia just as the disease 
began to make its appearance, had formed little or no ac- 
quaintance with the inhabitants, and of course had no inter- 
course with the sick. This, and this alone is the true reason 
of their escape, and is a very strong and direct proof that the 



not derived from th> whi< h h 

;iucl 1>\ those who contend that it is of domestic i 
and not contagiou . 

11" the disease had arisen from th< eady 

enumerated) or from the joint effect of these and a derail 

of the atmosphere, all that breathed the air of the city, 
at least, if not all round the world m the same latitude, would 
have suffered moi by it, and nearly at the same time, 

and not in that gradual and su manner as they have 

iy time the yellow fever has made its appearance in 
any of the seaport towns of this country, and as is observe!} 
always to be the case with all the diseases that are acknow- 
ledged to be contagious. 

The symptoms, also, by which the yellow fever is distin- 
guished from the most dangerous cases of the bilious fever 
that occur in any part of the world, not excepting the indige- 
nous fevers of Batavia, Calcutta, Goree, or Surrinam, which 
are universally acknowledged to originate from the exhalations 
of putrefying animal and vegetable substances, furnish addi- 
tional evidence of their being different not only in degree, but 
in kind, and consequently that they are derived from different 
sources. 

To infer that the yellow fever is only a variety or higher 
grade of the indigenous intermittent fever of this country, 
because it generally occurs, progresses, and terminates at the 
same time of year as the intermittent, is confounding or mis- 
taking coincidents for causes. By this mode of reasoning the 
plague of the Levant, with all its complicated horrors, would 
be nothing more than a common intermittent, rendered ma- 
lignant, or increased in power by the influence of a deranged 

of the constitution of the atmo 'oor. its cause, or 

in 



I 



74 

upon the constitution of the patient ; for, when it has been* 
imported into the temperate climate of Europe, from Egypt, 
Syria or Turkey, it has generally commenced, progressed, 
and terminated in the same seasons as the common intermit- 
tent. For proof of this, see Hodge's account of the plague in 
London, in 1665, and Mertin's account of its rise and progress 
in Moscow, in 1771. 

If coincidence of events always depended on identity of 
cause, the pleurisy and the measles would depend on the 
same cause, and though differing in degree, and in the cha- 
racter of their symptoms, they would be the same in kind, 
and agree in their nature, and would require a similar mode 
of treatment; for, according to Sydenham's account, they 
both begin in the month of February in the climate of Eng- 
land, increase during the spring months, and terminate about 
the summer solstice. 

The only circumstance in which the yellow fever and the 
intermittent or bilious fever do agree, is, in being both de- 
stroyed or disarmed of their noxious power by frost. This, 
however, only proves that the contagious principle, which is 
the cause of the yellow fever, requires the same portion of 
caloric to preserve its volatility, and keep it suspended in the 
atmosphere as the miasmata of marshes, or the exhalations 
from putrefying substances, and that it requires considerably 
less calorie to render the contagion of the typhus of temperate 
climates volatile, and to keep it suspended in the atmosphere. 
But the contagion of the yellow fever, like that of the typhus 
or jail fever, requires to be accumulated or concentrated in 
the atmosphere in confined and unventilated situations, in order 
to render it capable of producing any disorder in those exposed 
to it; and as the poison of arsenic becomes harmless by co- 
pious dilution in water, that also becomes harmless by diffu- 



air. This is the reason \\ m thi 
ommunicated from one to another in country si 
tions, where there ia a con illation of fresh air. They, 

then loi\-, who deny the yellow fever to be contagious in anj 

situation, because it is rarely BO in the open and Tree air of the 
country, might with equal reason deny that the jail or hospital 

r, the typhus gravior of systematic writers, is contagious, 

because it oar) operates in confined and unventilated situa- 
tions, where cleanliness is neglected, with sufficient power to 
produce any morbid effect ; but like the noxious gases, or 
other volatile poisons, becomes impotent and inactive by dif- 
fusion, or by mixture with a certain portion of fresh and 
untainted air. Those, therefore, who seem to think it so 
very extraordinary that the yellow fever, if contagious, does 
not produce the same noxious effects in the country as in the 
confined and less pure air of a populous city, I refer for a 
satisfactory explanation to a collection of facts on this subject 
published in Dr. Barton's Medical and Physical Journal, vol- 
2d, part 1st. I shall now conclude with observing, that if the 
circumstances stated and detailed in the preceding pages are 
authentic and correct, and I challenge any person to disprove 
them, every disinterested and unprejudiced inquirer that 
examines and compares them with the facts and arguments of 
the advocates of the domestic origin of the disease must be 
convinced, that the yellow fever has never originated from 
domestic causes in this climate, but is exclusively of foreign 
origin. 

TREATMENT. 

My experience convinces me that bleeding is not only user 
fid but absolutely necessary during the first two days of the 
disease, in all cases where inflammatory symptoms evidently 
predominate, especially when strong and quick pulsation of 






70 

the temporal and carotid arteries indicate local increased 
vascular action in the system, and particularly in the head. 
The quantity of blood to be drawn and the frequency 
of repetition should always be proportioned to the vio- 
lence and urgency of the inflammatory symptoms; but, 
great caution should be observed in repeating this remedy 
after the second day of the disease, especially in any large 
quantity, unless mercury has been given from the beginning 
and has begun to affect the mouth, as it has been observed 
frequently to induce or to increase the new and more dan- 
gerous train of symptoms, which in very dangerous cases 
usually occur at or soon after the beginning of the third day. 
A repetition should also be avoided, if the patient's general 
strength as well as that of his pulse, is very much reduced 
after the first operation, as in cases where nervous or putres- 
cent symptoms have existed from the commencement, or have 
come on in the course of the fever, bleeding has done irrepa* 
rable injury. 

Purging is proper under the same circumstances, and with 
the same limitations as blood-letting, and ought to be regula- 
ted in the same manner. 

The late Dr. Hodge has repeatedly assured me, that he has 
frequently arrested the course of this disease by bringing on 
an artificial cholera morbus by means of a solution of tartar- 
ised antimony exhibited at short intervals immediately after 
one copious bleeding. But as in this fallacious disease, the 
inflammatory symptoms are very often suddenly followed by 
those of an opposite character, and as mercury after it has 
entered the system, has been found a more certain preventa- 
tive of this unfavourable and dangerous alteration in the cha- 
racter of the disease, than any other remedy, purges in which 
it is a principal ingredient, should have the preference. In 



rr 

tses t] mce of the antiphl 

men has been found beneficial, and the application of linen 
ith cold \ i, to the fore part of 

the head alleviated the excruciating pain of that pari. Wet- 
ting the face and handa frequently with a cloth dipped in i 
so a cooling and refreshing effect. 

In this stage of the disease the affusion of cold Water, du- 
ring the exacerbation of the fever, as recommended by Dr. 
James Curric, in cases of typhus level-, has been found highly 

icial in reducing the febrile heat and bringing on a more 

ible remission ; but, (when the pulse is strong and the 

heat great) wetting the surface of the body, (including head 

and limbs) with cold water, or vinegar and water, by means 

sponge or napkin, and repeating the application before it 
becomes entirely dry, is more certain in allaying the preterna- 
tural heat, and reducing the action of the heart and arte- 
ries. This application appears to produce those salutary ef- 
fects by the evaporation of the water which abstracts and car- 
ries off the febrile heat with it. 

This form of the disease resembles the eruptive fever of 
the small-pox, and is generally subdued by the same remedies 
that render the pustules distinct, and the subsequent symptoms 
mild. When, how r ever, the recited means were neglected or ap- 
plied too sparingly or irregularly, the inflammatory symptoms 
were generally succeeded by those of a malignant aspect. 

From recent occurrences, I am satisfied that mercury ju- 
diciously and guardedly employed, after the activity of the 
arteries have been reduced by bleeding and purging in con- 
junction with the external application of cold water, is the 
remedy most to be relied on in every form or variety of this 
disease, so long as the external heat of the skin is considerably 



7H 

greater than in health. The cold water should be applied by 
means of a sponge or napkin at the commencement of the 
fever, when the heat of the skin is greater than in health, and 
the mercury should be given so as to affect the mouth, before 
the period at which the symptoms of the second stage usually 
come on. For this purpose, after the operation of the mer- 
curial purge, I have found two grains of calomel given 
every two, three, or four hours day and night, according 
as the stomach would bear it, and the application of 
two drachms of strong mercurial ointment to the body three 
limes a day, answer more certainly than any other method of 
employing it, observing to combine the calomel with opium 
when it affects the bowels toQ much, or to give it at; longer in- 
tervals. 

When not employed till the accession of the second stage, 
at which time the stomach was generally disordered it con- 
stantly aggravated the disease, and hurried on the fatal symp- 
iom of black vomiting. 

In this stage of the disease, when a disordered stomach is 
the predominant symptom, which dissections shew to be ow- 
ing to the inflammation of its surface, topical bleeding, by 
means of cupping-glasses or leeches, or when pressure with the 
hand on the stomach occasioned acute pain, and the pulse 
though small in volume, continued hard and tense, bleeding 
from the arm, repeated at short intervals, the frequent exhir 
bition of mild laxatives in small doses, particularly Epsom 
salts, soda phosporata, soluble tartar, castor oil, an infusion 
of senna and cream of tartar ; and when these could not be 
retained on the stomach, laxative clysters were the most use- 
ful remedies, especially when immediately followed by the ap- 
plication of blisters to the stomach, wrists, and ancles. A so- 



lutioo of the carbonate of soda in water, which is much iriore 

palatable than tin vegetable alkali, followed by a spoonful of 
Union juice, or a solution of cream of tartar in water, had 
also tlu- effect sometimes of allaying tin- distressing propen- 

to puke, so common in the second this disei 

after the febrile symptoms appeared to have subsided. But 
is well as every other that 1 have ever seen em- 
ployed, were too frequently of no avail. 

At the eitv hospital in 1805, a table spoonful of acetated 
ish in a draught of warm sage tea, as well as salt of worm- 
wood and lemon juice given in a state of effervescence, fre- 
quently settled the stomach, particularly when preceded by 
the warm bath ; and a return of the vomiting in many cases 
was prevented by the application of blisters to the back or 
stomach and to the wrists and ancles, immediately after be- 
ing removed from the bath. Perspiration was also sometimes 
promoted in this stage, by small and repeated draughts of an 
infusion of eupatorium perpoliatum, or, when that was disa- 
greeable to the patient, by an infusion of dittany or sage. 

The vomiting as in other diseases was also sometimes a! 
leviated by a table spoonful of the following mixture taken ira • 
mediately after every effort to vomit — 
5>. Succ. limon. 5vi. 

Sal. alk. vegetab. (pearl ash) q. s. 
Saturare cum succ. limon. cui add, aq. 
Menth. simp. giij. et 1-4 misce. 

>ome of my medical friends have assured me that they 
found good effects from the use of the artificial Seltzer wa- 
ter, in cases of alarming debility, attended with almost irce< - 
saut vomiting. 



80 

When the patient complained of a burning sensation in the 
stomach, calcined magnesia in large and repeated doses mix- 
ed with mucilage of gum arabic, or with sweet milk and wa- 
ter frequently afforded relief. Where no remedy could be 
retained on the stomach, injections, consisting of from half 
an ounce to two ounces of spirits of turpentine, and three or 
four ounces of warm water, were administered by the physi- 
cians of the city hospital and repeated at short intervals, till 
they occasioned tenesmus, after which the vomiting frequent- 
ly, but by no means generally, ceased, and the stomach re- 
tained such medicines or nourishment as were prescribed. It 
is with regret I have to add that a majority of the patients 
died notwithstanding this effect of the terebinthinate injec- 
tions in suspending the vomiting ; the inflammation, which 
from no abscess being discovered in the stomach of any one 
that died of this fever, being probably of the erythematous 
kind, spread through the whole surface of the intestines. 

As dissections shew that the constant propensity to puke 
upon taking any thing into the stomach, which so generally 
occurs on the third day from the attack in this disease, de- 
pends upon an inflammation of the surface of that organ, and 
as the indication is to remove this inflammation, what effect 
would iced water or iced cream have upon it ? 

Cupping upon the stomach, or drawing blood by leeches, 
and the application of blisters, are certainly indicated in this 
state of the stomach, but I have no experience of the effects 
of cupping or leeches in such cases. 

In more than one case, the disorder of the stomach ceased 
immediately after the application of a large poultice of the 
flower of mustard to it and to the feet ; in another, lime wa- 
ter diluted with simple cold water, removed the complaint : 



81 

Thi ten in small and repeated draughts, vis . 

blc spoonful with the same quantity of sweet skimmed milk. 

1 hai rnrable opinion of the warm bath in this state 

of the disease, when disorder of the stomach appears to be 

the most predominant symptom, especially when aided In the 
application of blisters or sinapisms, immediately after coming 
out of the bath. But 1 have seldom had an opportunity 
of employing the warm hath in private practice for want of 
suitable assistance; for rendered callous by the dread of con- 
tagion, 

" Dependants, friends, relations, love himself, 

t the tender tic, 
The sweet endearments of the feeling heart." 

In the second stage of the disease when disordered sto- 
mach and apparent debility, were the most remarkable symp- 
toms, stimulating remedies and an invigorating regimen ap- 
peared to be indicated, but the inflamed and irritable state of 
the stomach, rendered them inadmissible and highly danger- 
ous. 

In these circumstances the internal use of mercury alcne 
or combined with opium, always increases the propensity to 
puke, and when it failed to purge, aggravated the complaint 
and the external application except when begun with at an 
earlier period of the disease, seemed to have no sensible ef- 
fect. Dr. Davidson of St. Lucia in a letter to Dr. Buxton, 
dated October 14th, 1801, recommends for the distressing- 
vomiting which so generally attends the second stage of this 
disease, a clyster of assafoetida, with the addition of two hun- 
dred drops of laudanum, and afterwards the extract or tinc- 
ture of opium, to be given by the mouth at proper intervals, 
to prevent the return of this dangerous symptom, and he as- 
serts that though he has seen this complaint aggravated by 

11 



82 

opiates, given by the month, they have always afforded relief 
when given in clysters. 

"Whether under these circumstances, laudanum given as re- 
commended by Dr. Davidson is entitled to the encomium he 
bestows upon it, my experience does not qualify me to deter- 
mine, but I have employed it several times in the quantity of 
sixty or eighty drops in warm carminative clysters, in cases 
where vomiting appeared to be owing to exhaustion, from too 
copious depletions, with the most immediate and sensible be 
nefit. 

In cases of black vomiting, which is generally a hopeless 
symptom, I am greatly deceived if I have not sometimes 
seen laudanum in moderate doses produce good effects when 
given in a clyster made of a strong decoction of Peruvian 
bark and snake-root, frequently repeated. This dreadful 
symptom, however, has been more frequently relieved by a 
mixture of equal parts of lime water and new milk, taken 
from one to four table spoonfuls every hour or oftener, than 
by any other remedy, when employed on the first appearance 
of that symptom. 

In the year 1798, in the case of Mr. Fendal, it completely 
relieved the vomiting, and he recovered after he had been 
reduced to the most hopeless extremity. 

Several instances are mentioned by Dr. Hosack of its sue* 
cess, at New- York, and the late Dr. Vaughan informed me 
that one had recovered by the use of it, under his direction 
at Wilmington. Perhaps this remedy from its sedative and 
mildly astringent quality, as well as from its correcting the 
acid which generally abounds in the stomach, previous to the 
commencement of the black vomiting, would be more efnea- 






> enting tlian in remcn ing the black vomiting, it i 
■ arlier in the d 

In one can under my care, given diluted with water, it 

tettled the patient's stomach when neither effen c s< ing mix- 

s nor clysters with laudanum had any effect. In another 

, twenty grains of the carbonate of soda, dissolved in cold 

water had a similar effi 

When the disease began with weak pulse, general debility, 
considerable oppression about the pnecordia, and great rest- 
. accompanied with deep and frequent sighing, I con- 
sidered myself justifiable from the analogy of the disease 
with the putrid or ulcerous sore throat, and from my con- 
stant failure with every other remedy, as well as from the ex- 
perience of Dr. Chisholm, (who first employed mercury for 
the purpose of producing salivation in this disease), to have 
recourse to mercury, guarding it from passing off by stool, 
by combining it with opium, if the bowels were disturbed by 
it, carefully guarding against any considerable evacuation till 
the mouth became affected ; and would advise to begin with 
it as soon as possible after the commencement of the disease. 
Confiding in the correctness of Dr. Patterson, a physician in 
the British army, who declares in a letter to Dr. Chisholm, 
that he had found the early application of blisters to the sto- 
mach and limbs prevented a determination to that organ, I 
have in every case when I prescribed mercury, directed a 
large blister to the stomach, and smaller ones to the wrists 
and ancles, at the same time ; and after the removal of the 



* Dr. Dalcho of Charleston says he gave aq. calcis to several patients in 
the year 1805, whose stomachs were greatly disordered, and that it gene- 
rally settled them and prevented the black vomit.— Dalcho's Oration before 
Medical Society of Charleston, published in Coxe's Museum for June 
and Julv 1805. 



84 

blisters, have dressed the excoriated surface with strong mer- 
curial ointment, and directed the ointment to be rubbed on 
different parts of the patient's body at the same time, when 
insuperable prejudices were not opposed to its use. 

Though ray success with this mode of treatment has not 
been very flattering, it certainly failed more seldom than any 
other method that I have hitherto had an opportunity of see- 
ing tried, and if I could conveniently have employed the af- 
fusion of cold water as an auxiliary, I have reason to believe 
it would have been much more successful* 

In every ca3e, however, that has come under my observa-* 
tion, where the employment of mercury has been deferred 
till after the dangerous and distressing symptoms of the se- 
cond stage have come on, it has either aggravated the dis^ 
tress and increased the danger, or has been of no avail ; and 
when employed after signs of putrescency or scorbutic symp- 
toms have made their appearance, such as purple spots on 
the surface and hsemorrhagies from the mouth and other 
parts of the body, it has invariably accelerated the fatal event, 
notwithstanding the declaration of Dr. Chisholm and others 
to the contrary. Haemorrhage from the nose, however, at 
the beginning or during the first stage, was generally bene- 
ficial. 

I am convinced from a comparison of the success attend- 
ing different modes of treating this disease, that mercury 
when employed from the beginning or early in the first stage 
of the disease and skilfully conducted is more efficacious than 
any other remedy, especially when suitable auxiliaries are emr 
ployed at the same time. It is certain that very few have 
died after salivation has been produced, and I am inclined to 
believe that the difficulty of producing this effect, is frequent* 



I to the want of applying the remedy on the first ap- 
,inu ol the disease, and regulating the action of the arte- 
i kd system, at the same time, according to the indications of 
mptoras* 

Hut when mercury is given late in the disease, or at any 
the stomach has become constantly disordered, 
il is not only an uncertain remedy but one of the most dan- 
gerous and destructive poisons that can be employed. 



Order II. PHLEGMASIA. 



The phlegmasia; or topical inflammations accompanied 
with fever are a very numerous assemblage of diseases. Their 
great characteristics are, the general symptoms of fever, 
and a topical inflammation attended with pain and disorder of 
some important function. And in most instances, when blood 
is drawn, it is found upon coagulation to be covered with a 
sizy or glutinous skin or film resembling tough jelly. Un- 
der this order many important genera are comprehended, 
each requiring a separate consideration.* 

' The remaining orders of pyrexia, with the exception of the exanthema- 
ta, viz. the phlegmasia-, hemorrhagic and profluvue, differ essentially from 
the order of idiopathic fever; for in the latter orders the fever is always 
the effect of the local affection, and is so constantly proportioned to it, 
that we can almost always judge with precision of the violence of the lo- 
cal affection, by observing that of the febrile symptoms. For this reason 
Dr. Alexander 1*. Wilson, a writer of acknowledged ingenuity, in his Trea- 
tise on Febrile Diseases, has divided the pyrexiae into two classes, viz. idi- 
opathic and symptomatic. This writer says we are to look for the prori- 
nuitc cause of inflammation in the capillary arteries, and not in the larger 
ones. This he thinks consists of a morbid distension of the capillaries, and 
fchc ncce^ary consequence of this distension an increased action of all the 



I* 



OF PHRENITIS, 



OR 



INFLAMMATION OF THE BRAIN. 



Thi6 disease (which belongs to the phlegmasia or second 
order of the first class, and ninth genus of Dr. Cullen's noso- 
logy) is an inflammation of the parts contained within the 
cavity of the cranium, and may affect either the membranes 
of the brain or the substance of the brain itself. 

The symptoms by which phrenitis may be most certainly 
known, are a vehement pyrexia, a violent deep seated head- 
ache, a redness and tingescence of the face and eyes, an im- 
patience of light or noise, a constant watching and furious 
delirium. 

The remote causes are the same as those of inflammation 
in general, operating more directly upon the head. And the 

larger arteries from whence the capillaries arise. In other words, " inflam- 
mation seems to consist in a debility or want of due resistance in the con- 
tractile power of the capillaries, in consequence of which the blood im- 
pelled into them in the course of the circulation distends them and stag- 
nates, or at least loiters too long- in them, the consequence of which is that 
the larger vessels from which they are immediately derived, are morbidly 
distended and stimulated to a stronger and more frequent action to relieve 
themselves from the stimulus of distension. The inflammation terminates 
as soon as the capillaries are so far excited, and the larger arteries so far 
weakened by their excessive action, that the force of the capillaries is iu 
due proportion to the force a tergo." 






cure of phrenitis ib the SUM ITIth that of other inflammations; 
m phrenitis the most powerful remedies Lire immediately 
rcqui 

TREATMENT. 

From twenty to forty ounces of blood should be drawn in 
as short a time as practicable, from vessels as near as possible 
to the head, and repeated in less quantity even' six or eight 
hours at farthest, till the symptoms are considerably abated, 
particularly from the jugular veins, or from the temples, by 
scarifying and cupping. A puncture may be made with a 
lancet in the artery of one of the temples with perfect safety 
by a person accustomed to surgical operations, and the bleed- 
ing stopped with ease by moderate and steady pressure. 

Immediately after the first bleeding several folds of linen 
wrung out of cold water should be applied to the head pre- 
viously shaved and cupped, and renewed as often as they be- 
come nearly dry. 

Purges which operate speedily and copiously are the next 
remedy to be employed. 

$. Pulv. jalap. 3j. 
Calomel. 5ss. 
Crem. tart. 3ij 
Misce. et f. chart, no. iij. 
One to be given every two hours till they begin to operate, 
and the operation to be promoted by thin gruel or barley 
water. 

If jalap is not preferred, an ounce of salts and half as 
much senna infused in a draught of boiling water, sweetened 



88 

with manna Or brown sugar and the addition of one grain of 
tartarized antimony may be given, and half that quantity re- 
peated every two hours till it operate six or eight times, or 
from five to ten grains of calomel, and twice as much jalap 
made into pills may be given every three or four hours till 
they have the desired effect. But no kind of anodyne must 
be admitted after the operation, otherwise it will aggravate all 
the inflammatory symptoms. When the pulse is nearly as 
low as in time of health, and the skin continues to be hot and 
dry with symptoms of delirium, the following antimomal 
powders will be proper. 

§>. Tart, emetic grs. iij. 

Pulv. sal. nitri. 3 iij. misce. f. chart. No. XII. 

The patient is to take one of these powders every second, 
third or fourth hour, according to the violence of the symp- 
toms, dissolved in a draught of cool beverage, barley water, 
or toast and water, and continue those or similar drinks, aci- 
dulated with vegetable acid, from the commencement to the 
termination of the disease. No aliment except barley w r ater, 
or thin oatmeal gruel, should be allowed during the continu- 
ance of the delirium and fever. The remedies most to be 
depended on are, copious bleeding, cupping, and the applica- 
tion of vinegar and cold water, or ice to the head. Blisters 
should be applied to the head, as soon as the blood vessels 
have been freely emptied ; but when applied before copious 
depletion of the blood-vessels, they have not appeared to have 
had any sensible effect upon the complaint. It is of the greatest 
importance to keep the patient's chamber not only temperate, 
but in a condition which to a person in health would feel disa- 
greeably cold. When the season prevents this, it should be 
ventilated as much as possible, and all the drinks given cold, 
except while a purge is operating, and even then not more 
than of tepid warmth. 



I mid be excluded as much as possible, Ci 
with free ventilation, and n tttbwedin 

tin- chamber. 

The delirium which I have frequently met with in practice, 
i after parturition, in consequence of too long exposure to 
:. particularly in persons whose labour has been tedious or 
difficult, usuallv called Puerperal Mania, from the circumstan- 
.md situation of the patients in whom it occurs; I have 
atedly seen completely cured by the same remedies as 
those directed for the cure of the most furious delirium.— 
For though the pulse is not hard or tense at the wrist, it is 
always more or less tense and prcternaturally frequent in the 
temples and carotids — and dissections have shewn that it de- 
pends on an inflammation of the substance of the brain. 



OF THE HYDROCEPHALITIS, 

Or that Affection of the Brain, which in Infants 
and Young Children, usually terminates in an 
Effusion of Water into the Ventricles, commonly 
called Hydrocephalus Internus. 

This disease is confined almost exclusively to infants and 
children under the age of ten years, (though, it sometimes 
appears at a much later period), and is one of the most insi- 
dious and dangerous of the diseases which occurs. 

It sometimes comes on suddenly and cuts the patient off 

from the number of the living, in a few days ; but it frequently 

comes on more gradually, and in such cases is several w< 

13 



90 

before it terminates ; and when it does terminate after being 
protracted so long, it generally terminates fatally. 

The symptoms of the Hydrocephalics, for the first two 01 
three days, bears such a strong resemblance to an irregular 
remittent, or to the symptoms which are supposed to arise 
from difficult teething, and in infants at the breast to certain 
affections of the bowels, that physicians are apt to be misled 
with respect to the real nature and seat of the disease, till it 
becomes firmly established, and the accession of the symptoms 
of the second stage, convinces them of their mistake. — We 
however, ought always to suspect the existence of that inflam- 
mation or congestion in the vessels of the brain, which pre- 
cedes the effusion of lymph into its ventricles, when the patient 
has a flushed face, contracted pupils, hot skin, and preterna- 
turally quick and irregular pulse, accompanied with obsti- 
nate costiveness, and especially if he shuns the light, covers 
his eyes, and puts his hands frequently to his head, and is 
restless and peevish, and after a short or partial sleep, wakes 
suddenly, screams out, and if at the breast, sucks with avidi- 
ty, or bites the nipple with violence, and moans like one in 
pain or great distress. 

When the patient is of an age to describe his feelings, he 
complains of his head and the back part of his neck " hurting 
him ;" is feverish, restless and peevish, and feels sick, and 
attempts to puke upon being held up, though in this stage he 
seldom brings off much from his stomach.' — After a few days 
however, he becomes drowsy, silent and sullen, and has a very- 
great aversion to any kind of motion or disturbance ; at 
length however, the disease, unless early relieved by art, takes 
on a new form, in consequence of the water which escapes 
from the over distended and relaxed extremities of the lym- 
phatic arteries, and is deposited in the ventricles of the brain, 



This change in th< mtl nature of tlv* symptoms in somtt 

dden and instantaneoi ion 

gradual, but which in proportion n i has been 

greater oi leaa quantity, points out with more or less certaintj 
the existence of the second stage of the disease. 

The congestion of US vessels of the I 

being reduced, b) I 

the pain of the head and f 

for some hours, so much re- 

el of his dison ela ii - and attendants are 

deceived into an ej * his speedy recovery The 

patient however, c J r to be lifted up or held in an ei 

posture without ig sick at stomach, and making efforts 

to vomit, and sometimes vomits incessantly till again laid in 
a horizontal posture. — The pulsehowever, soon become quick 
again, the skin hot and dry, and the tongue white ; the cos- 
tiveness also continues or returns, and for some time the eyes 
and pupils retain the healthy appearance which they had 

:ned after the commencement of the effusion, but as the 
ventricles become distended by the accumulating water, the 
face exhibits transient flushings, resembling the blush of a 
person of exquisite sensibility ; the pupils become dilated, and 
when the distention of the ventricles from the accumulating 
water has increased to a certain extent, the pupils become 
remarkably large, accompanied with strabismus or squinting, 
and insensibility to light, which are gradually followed by 
lethargy, and generally palsy of one side, and finally stertorous 
breathing, apoplexy, or convulsions and death, previous to 
which the patient lies with his eye -lids half open, and 

! turned towards his nose, and so far upward as to lej 
only the opaque cornea visible. 

For some time previous to the accession of coma, dilated 



92 

pupils and strabismus, the pulse becomes so frequent, in con- 
sequence of the irritation from the effused fluid in the ventri- 
cles, that it is almost impossible to count it ; the number of 
pulsations sometimes exceeding one hundred and sixty in a 
minute. 

This disease as characterized by the state of the pulse and 
the sensibility of the pupils of the eyes, may be divided into 
three stages. In the first the pulse is frequent, irregular, 
and generally full, but never tense or hard, that 1 have ob- 
served ; the head is in pain, the face red, the pupils remarka- 
bly small and contracted, the tongue white, and the skin hot 
and dry, especially about the head and neck. 

In the second stage the symptoms of pain and all the fe- 
brile symptoms, subside for a short time, and the pupils of 
the eyes resume a healthy appearance, though the patient at 
this period generally feels sick at stomach when lifted up or 
raised from his pillow, moans when laid down again, and has 
an aversion to motion or any kind of exertion. 

In the third stage, the pulse, which in the second stage had 
apparently returned nearly to its healthy state, again becomes 
preternaturally frequent — the pain of the head returns, at- 
tended with great thirst, white tongue and hot skin, which 
after a longer or shorter duration in different cases, are suc- 
ceeded by constant drowsiness, interrupted sleep, slower and 
more irregular pulse, accompanied with great moaning and 
frequent and sudden screaming; and when the patient has 
teeth he frequently grinds them with great violence; all of 
which are succeeded by the symptoms of the third and last 
s^age, which have already been enumerated. 

It is evident from the appearance of the brain of persons 









(layc di< the 

ol light in r 

ner \\ ith preternatural ible contrac- 

don of the pupils, and in the lal lira! 

dilatation and insensibility of the same, arise from opp< 

ditions of that organ. The former depending on an in- 
flammation or congestion peculiar to the ir. 
disease in persons oi he latter supervei 

in the latter stage, in consequence of effusion and the dis- 
tention and compression occasioned thereby* 



CAUSES. 

From the appearance of the brain in the dissections which 
1 have Been and a comparison of the symptoms which pre- 
asually attend the first stage of this disease, with 
of other alTcctions of the brain or its membranes, I am 
of opini partakes more of apoplexy than of phre- 

The proximate cause of the former of which is an 
.ircd power, and consequent congestion of blood in the 
larger trunks of the arteries of that organ, and designated 
by more or less insensibility and propensity to lethargy ; 
.eas, according to the theory or pathology of Br. Alex- 
ander P. AVilson (a physician of great research and ingenu- 
ity, who has published a treatise on febrile diseases) in cases 
of phrcnitis, the action of the capillary arteries is weak when 
compared with that of the larger blood vessels, and the dis- 
is distinguished by great muscular exertion and men- 
tal raving, wakefulness, and fur)-. 

ll is therefore presumable that the predisposing causes are, 
previous lever oi the intermitting kind, or any other disease, 



94 

which has the effect of determining the circulation more 
forcibly to the brain than to other parts of the system ; per- 
haps the abuse of anodynes may also be considered as one of 
the most frequent though the least suspected of the predis- 
posing causes. 

The most usual of the occasional or efficient causes are, 
long continued vomitings, by which the blood is forced into 
the weakened vessels of the brain; but blows on the head or 
sudden concussion of the brain by falling upon the head, are 
the most usual predisposing, as well as occasional causes of 
this very dreadful and distressing disease. 

As it is improper to name a disease from the symptoms 
or phenomena which it exhibits, after it has come to a crisis 
or changed its character, I have thought it advisable to 
adopt the name of hydrocephalics, as it conveys a more cor- 
rect idea of the nature of the disease, while it retains its 
original nature, form and character. In a state of perfect 
health all the four cavities of the brain do not contain more 
than from one half to a whole ounce of clear lymph ; whereas 
in persons who have died of this disease, and whose brains 
I have seen opened they generally contained more than four 
ounces, and in some cases nearly twice as much. 



TREATMENT, 

No one acquainted with the nature and usual progress of 
this disease will deny that if there be any means adequate to 
arrest it in its course, they must be for the most part em- 
ployed promptly and assiduously in the early part of the first 
stage. To accomplish this desirable end with the greatest 
certainty, one of the temporal arteries should be opened. 



91 

Di . i c;crv in the University of 

Pennsylvania informs me, that this operation is directed to be 
►rrned by Dr. Physic, profi ry, who is cele 

brated lor tin- dexterity and success of his operations) in tlu 
following manner, viz. when the temporal artery pulsates so 
Strongly that it may be distinctly seen, it may be very readily 
opened with the point of a lancet ; hut when the artery is 
i la! as to he distinctly seen, its precise situation 
and course ma) be ascertained by feeling its pulsations ; in 
oi re u instances it can he readily divided with the end of 
a sharp scalpel. The bleeding can be restrained without diffi- 
cult- by applying a compress over the orifice, which is to be 
secured in its situation by a bandage passed round the head. 
When however this operation is not submitted to, the patient 
should be held or propped up in an erect posture, and blood 
drawn from one of his arms, from a large orifice, with as 
much expedition as possible, till symptoms of fainting or ap- 
proaching convulsions indicate that the vessels of the brain 
are sufficiently unloaded, which ought to be the signal to 
desist. 

As soon as recovered from the immediate effects of bleed- 
ing, the patient should take, according to his age, from one to 
five grains of calomel, mixed in a spoon with any agreeable 
svrup or preserve, every hour till it has the effect of open- 
ing the bowels, three or four times at least, having previouslv 
shaved the whole head and covered it with a double linen nap- 
kin or compress, wet with cold water and vinegar, mixed to- 
gether in equal quantities, and renewing it as often as it 
becomes dry. 

As soon as the operation of the calomel appears to be over, 
if symptoms of Ifever and congestion still exist, the bleeding 
bhould immediately be repeated to nearly the same extent as 



06 

at first, and immediately after its operation a large blister 
should be applied over the whole head, and one to both wrists 
and ancles ; or, if the stupor has increased, sinapisms to the. 
soles of the feet, and the calomel should be repeated again as 
at first. But if the eyes appear red and prominent, and the 
pupils enlarged, without being accompanied with strabismus, 
instead of drawing blood from the temple or arm by means 
of a lancet, cupping glasses or leeches should be substituted—— 
or after the application of leeches, cupping glasses may be ap- 
plied to the orifices which they have made. When the dis- 
ease occurs in remote parts of the country, where these can 
not be procured, the skin may be scarified to some depth 
with the point of a lancet, and a common small decanter appli- 
ed to the punctures the instant the hot water, with which it 
should first be filled, has been poured out of it, which in con- 
sequence of the vacuum occasioned by the heated water, will 
occasion blood to flow into it from the punctures, if properly 
managed. 

"When the operation of the calomel is tardy, it may be 
quickened by giving a small draught of the common infusion 
of senna leaves, between the doses, or a small dose of jalap 
and cream of tartar, a solution of epsom or glaubers salts, sal 
solubile, &c. or if these are refused by the patient, recourse 
should be had to purging clysters. . 



Wheia from too long delay, in the employment of the re- 
cited remedies, or from the too sparing or injudicious manner 
of applying them, or from the inefficacy of their power to arrest 
the disease in its progress, and prevent it from ending in a 
dropsy of the ventricles ; the change in the nature and form 
of the disease, requires a change in the nature and form of 
the remedies. 



and power ol 
npaircd in consequence of the preceding i tion 

and distension of tin »m v, hi QCC the ( xfi.i 

lents proceed, admits a greater quantity of watery fluid to 

ipe and flow into the ventricles than usual, and cop 
quently than the absorbents are capable oi taking up and 
disposing of j hence it accumulates, distends the brain an! 

nst the nerves at their origin, and ren 
them le to customary impressions ; hence the propen- 

lumber, and as the quantity of this fluid increases, the 
pupils of the eyes become enlarged and insensible to the sti- 
mulus of light, accompanied with strabismus, and turning 
the eves upwards, only the whites of the eyes being visible, 
and the eye lids remaining half open. 

Here the indications of cure are in a great measure the re- 
verse of what the}- were in the preceding stage and state of the 
disease, though our attempts should still be directed to with- 
draw from and to prevent a return of the determination of the 
circulating fluids to the brain, and by that means any farther 
effusion of wateryfluid into the ventricles, while we at the 
same time employ such remedies as have the effect of increa- 
sing the tone and power of the exhalents, and promoting the 
action of the absorbents of the system in general, and of the 
ventricles of the brain in particular. 

With this view fresh blisters should be applied to the head 
and limbs, unless those which had been applied in the former 
stage of the disease still continued to be considerably infla- 
med, in which case they need only be dressed with basilicon 
with the addition of a little red precipitate, finely powdered 
cantharides, or powdered savin leaves. The antiphlogistic 
regimen, though not with the same strictness, is also to be 
continued. 



i 



98 

Small doses of* digitalis are to be administered at stated 
intervals of from four to eight hours, of which either the 
powder of the leaves lately dried in the shade, or the spiri- 
tuous tincture, may be prescribed at the option of the physi- 
cian. From half a grain to two grains of calomel should 
also be given every four hours between the doses of the digi- 
talis, so as to alternate with each other, and continued daily 
till a swelling of the gums and soreness of the inside of the 
cheeks are the consequence, or a salivation begins to make its 
appearance. As a salivation, however, can rarely be produ- 
ced in infants or young children, we must judge from other 
appearances when the mercury has sufficiently pervaded the 
system of the patient, the principal of which are, a greater 
j£--,?s of the pulse, with redness of the face and inside of 
.. cheeks, accompanied with offensiveness of the breath, 
small vesications on the tongue and inside of the lips, and 
especially when a more favourable change takes place in the 
symptoms which had denoted the existence of water in the 
brain. After which the calomel should be discontinued for a 
day or two, and afterwards repeated at longer intervals and 
in smaller doses, - till every morbid symptom appears to be 
completely subdued. 

The digitalis should also be discontinued as soon as it has 
had the effect of rendering the pulse a few strokes slower than 
it usually is in patients of the same age, when in health ; but 
may be occasionally resumed as the accelerated state of the 
pulse ma)'' require in the course of the disease. 

The precautions requisite to be observed in the use of di- 
gitalis may be seen by turning to the chapter on phthisis pul- 
snonaiis, where the? will be minutely specified. 



Mercury should never be given in large quantities or a) 
short intervals in this dis^ for want of o1 this 

precaution, I have known n, instead of occasioning salivation, 

to brim; on an inflammation of one of tin- < lui les Or of llir 

side of the face, which in spite of all the usual 

ventatives, ended in a mortification, which either speedirj 

deprived the patient of his life, or if he recovered, left him a 

Jelormecl and shocking spectai le the remainder of his clays. 

When nnuurv cannot be administered inwardly in this 
, either alone or united with a due proportion of opi- 
um, or any Other medicine, without disordering the stomach 01* 
bOweis, every one knows that the external application of die 
blue mercurial ointment will produce the same effect as mer- 
cury taken inwardly. The quantity and manner of employ- 
ing which, may be seen in the works ©f srt'1 the modern au^ 
thors. 






100 



OF THfc 

CYNANCHE TONSILLARIS, ANGINA, QUINSY, 

OR 

INFLAMMATORY SORE THROAT. 



This name is applied to every inflammatory affection of 
the internal fauces. 

But these inflammatory affections are not only different on 
account of the particular part in which they are seated and 
the constitution of the patient, but from the nature of the 
causes by which they are produced. 

In Dr. Cullen's Nosology the cynanche (which is his tenth 
genus) is divided into five different species. But as minute 
distinctions are more apt to perplex and confuse, than to elu- 
cidate or direct to successful practice, I shall include them 
all, except the cynanche typhoides, (or putrid sore throat), 
and the cynanche trachealis, under the title of cynanche phlo- 
gistica or inflammatory quinsy. 

When the tonsils, palate and fauces are swollen and infla- 
med, attended with an increase of pain and difficulty in de- 
glutition, and an acute pain, sometimes darting into one or 
both ears, the disease is properly entitled to the name of cy- 
i : i he phlegmoides, or inflammatory quinsy. IJnder these 



s the pulse is always strong unci quick, the skin 
hot aiul dry, and the thirst git 

Tin laHy ushered In by n i hilly fit <»r alternate 

ions of chills and heats. After which the pu3 
quick and strong, and sometimes hard and b 

contagious, but is generally produced 
by * ■ to unusual cold, especially alter the body has 

n debilitated by fatigue, -or has been overheated by vio- 
lent - 

This disease frequently terminates by resolution, some- 
times by suppuration, but very seldom ends in gangrene. 

It occurs more frequently in the winter and spring than at 
any other time. The inflammation is commonly most con- 
siderable in one tonsil at first, but before that abates it gene- 
rally extends to the other. 



TREATMENT. 

The remedies which have been found to aflbrd the greatest 
service in this complaint, in general, have been early venesec- 
tion, saline purges, blisters upon each side of the throat over 
the tonsils, and the following gargle. 
§>. Pulv. borax 51. 
Acet. vini. $ij. 
Aq. communis Ibss. misce. 

This should be used cold and should be frequently re- 
peated. A gargle consisting of the sulphuric acid and cold 
water, according to Dr. James Sims, is still more effectual. 






102 

Dr. Kuhn has found benefit in his practice from the va- 
pour of vinegar, and the common domestic remedy of ni- 
tre and sugar-candy laid on the tongue, which he thinks are as 
effectual, if not more so, than the gargles usually recommend- 
ed. When the tonsils are greatly inflamed and painful, it will 
be proper to scarify them with a lancet. If they suppurate 
they may be opened with' a small trocar passed through a sil- 
ver canula. For the method of performing these operations, 
consult Bell's Surgery, vol. V. — or Smith's Abridgment of 
John Bell's Principles of Surgery, in one volume. 

The antiphlogistic regimen which consists principally in 
avoiding all stimulating or heating substances, is strictly to be 
observed in order to effect a speedy cure. 

The common practice of wrapping flannel about the neck in 
the early stage of this complaint, appears to be very injudici- 
ous, as the heat occasioned thereby must prove too stimulating. 
The volatile liniment or rubefacients are supposed to have a sa- 
lutary effect, as they operate in the manner of epispastics, only 
in a lower degree. An effusion to the surface, however occa- 
sioned, frequently unloads and takes off the tension from the 
internal vessels. Black pepper in fine powder, with as much 
brandy or other distilled spirits as will make it into a soft 
paste spread on leather and laid upon the outside under the 
chin, and moistened again as it becomes dry is recommended 
by Dr. Falconer in preference to volatile liniment in cases 
where blisters are not readily submitted to. This seldom 
blisters, yet affords considerable relief. Dr. Withering says 
he has " used emetics in the cynanche tonsillaris, angina, in- 
flammation or true quinsy, for many years with the greatest 
success. If the vomit is given on the first or second day of 
the disease and the patient keeps in bed, drinks gruel freely, 
itnd takes the tartar emetic in smaller doses to promote perspi- 



ration,)) Mil." fn general the most urgent 

itantaneously relieved, and ma day <>r t\ 
linns without repeating the emetic, tin 
patient is quite well. Dr. W. adds thai he never directs an) 
other medicines either internal or external, except an injected 
tin discharge of viscid mucus. 

In the cases of this disease, however, that have come tin* 
der the management of tin- editor, he lias generally found 
ling-, purging and antimonials aa necessary as in any 
Other phlegmonous inflammation. 



OF THE CYNANCHE TRACHEALIS, 

OR INFLAMMATION OF THE LARYNX, COMMONLY GALLED 

THE CROUP OR HIVES. 



V ^ this disease occurs most frequently in infants and young 
children, though it sometimes attacks adults, I shall confine 
my description of it to its appearance in children, from which 
its existence in adults will he easily understood. 

This disease is preceded by fretfulness, lassitude and drow- 
siness. It generally begins with a cough, resembling that of 
the catarrh, or common cold, but this cough is frequently 
accompanied with a peculiar shrill sound even from the first. 
This cough in the course of two or three days becomes al- 
most incessantly troublesome : it is then necessary to watch 



k 



104 

the patient with grsat attention. The dangerous attack is 
commonly made in the night, sometimes soon after the child 
is put to bed, but more frequently about midnight. 

The cough has a shrill, hoarse, dry, ringing sound, and 
returns in redoubled fits, the first of which, though very 
violent, is succeeded in a few minutes by a second, longer 
and more violent, and at its commencement is always ac- 
companied with feverish symptoms, which as well as the 
cough and dyspnoea generally remit in the morning ; but 
are again renewed towards evening or in the course of the 
following night. The face becomes swelled and flushed, 
and the eyes protruded, during the exacerbation of the pa- 
roxysms ; a general tremor takes place, and there is a kind 
of convulsive struggle to renew respiration at the close of 
each fit of coughing. There is no expectoration at this pe- 
riod of the disease. As the complaint increases the coughing 
fits generally become more troublesome in the evening and 
fore part of the night ; sometimes they become less frequent, 
but an incessant difficulty of breathing comes on, accompa- 
nied with an enlargement of the throat about the upper part 
of the larynx. The head is thrown back in the agony of at- 
tempting to escape suffocation, and the whole extensors of the 
trunk and of the legs, are sometimes thrown suddenly into 
action, to assist the effort, so that the whole body is bent 
backward as in tetanus. In this attitude and in this effort the 
patient generally expires. But in other cases the disease, af- 
ter continuing some time, appears suddenly alleviated, the 
breathing is free, the child suddenly becomes cheerful, his 
appetite for food returns, he amuses himself, and appears per- 
fectly relieved of his disorder, and the hopes of every one are 
raised only to make the disappointment more keen ; for the 
child soon grows worse and dies, his livid and swollen face 
and convulsive struggles giving him the appearance of one 
that is strangled. 



Win d the en. up i 1 1 1\ ourable, ii ten □ various I 

ml) after the disease lias arrived at its heij 
ii were a retrogression of the symptoi 
moist, the fevei sub tidi s, the ho i 
lastlj tlu (.(High, gradually wear away. Sometimes 
is followed by coughing up a viscid white substance, af- 
ter the disease has been of some days continuance* When 
the child dies after an illness of three or lour days, then 
found lining the windpipe a white substance resembling n 
membrane of considerable tenacity. It arises a little way he- 
me larynx, and is sometimes extended into the ramifica- 
tions of the bronchia?, and generally a quantity of white fluid- 
like matter, with which the lungs are filled, is seen gurgling 
up. The attachment of the membrane is slight, but the mu- 
cous membrane which lines the windpipe is inflamed. The 
inflammation which is still perceptible, and which of course 
must have been more violent before this fluid exuded, ap- 
pears to be the immediate cause of the violent symptoms du- 
ring the first stage of the disease; and the adventitious 
membrane and puriform fluid are the consequence of that 
inflammation, in the second and concluding stage. 

The membranous substance appears from experiments 

made with the usual tests to be the product of the coagulable 

lymph effused from the inflamed vessels on the surface of the 

trachea, which by confinement and the drying effects of the 

air in respiration becomes as firm as a thin membrane. In 

ral cases which I have seen examined after death the 

nbranc was attached to the trachea a little way below the 

glottis, was loose like an apron below, and was white and thin 

riting paper and nearly as tough as parchment ; a fluid 

mbling whey was observed under the membranous sub- 

I with small particles ling curd. 

14 



I 



106 

Dr. Ferriar says that he has seen this membranous sub- 
stance in different stages of the disease as the inflammation 
had extended down the surface of the trachea, from a consist- 
ent substance at the upper part, capable of being pulled and 
torn, to the form of a purulent fluid recently effused; Dr. 
Ferriar adds, if any other proof of the nature of the disease 
was wanting, I have received it in another manner, by seeing 
the croup supervene as an accessary disease, in two cases of 
ulcerated sore throat. There had been little general fever, 
and there was no scarlet eruption in either case. Though 
there were large ulcerations in the tonsils, there was at the 
same time vivid inflammation of the fauces. There was no- 
thing uncommon in the symptoms till the inflammation ex- 
tended to the trachea, when faint shrill coughing, hissing 
respiration and restlessness came on, which were soon followed 
by death. 

In a singular instance, says the judicious author last men- 
tioned, I have seen pneumonic inflammation converted into 
croup. The inflammation had subsisted during ten days, in 
a boy almost seven years of age ; the acute pain in the side 
was relieved, but the pulse continued very rapid, though not 
strong, there was a considerable degree of dyspnoea, and the 
cough was frequent, with a tolerably copious expectoration,. 
On the morning of the tenth day he complained of pain in 
his throat, and in the afternoon the cough began to assume 
the crouping sound. Leeches were applied to the throat, 
which produced a free discharge of blood, with an evident 
mitigation of the cough and dyspnoea. , An attempt was then 
made to excite vomiting, by emetic tartar ; but though given 
in large doses it ran off* by the bowels. Next morning the 
cough, was nearly gone, expectoration had entirely ceased, 
ihe respiration was hissing and difficult, and the pulse began 
to flag. Under these circumstances it was thought necessary 



toma< h in the most powerful mamu r 
Jue vitri fiven in solution, and as it produced 

qo effect seven grains more uri lively exhibited in the 

I the day. No vomiting followed, and suffocation 

took place. 

TREATMENT. 

I Ltt< d eater number of patients with tlic cynancha 

healis or croup in the winter and spring of 1808, than for 
many years before or since that time, within the same period, 
and almost always found blood-letting a useful and in many 
a a successful remedy, when employed very early and 
copiously, and repeated during the exacerbation of every pa- 
roxysm, as long as the dry ringing cough, croaking hoarse 
voice, difficult respiration and febrile symptoms continued, 
with but little or no abatement. A redness of the lips and 
flushing of the cheeks afford more certain evidence of the. 
lence of fever in this disease, than the pulse. But in se- 
veral cases, after the symptoms indicated that the preterna- 
tural substance resembling a thin membrane, so much taken 
notice of by the earl}- writers on this disease, particularly by 
Dr. Home, had formed in the trachea, and which frequentlv 
takes place in a very short time, if the inflammation of which 
it is the consequence is not speedily subdued, the existence or 
formation of which extraneous substance is indicated by the 
return of the cough and symptoms of suffocation accompa- 
nied frith a livid aspect of the countenance during the parox- 
ysm of coughing after the febrile and distressing symptoms 
have subsided ; blood-letting, instead of affording relief, has 
almost invariably increased the tendency to suffocation, and 
all the other alarming symptoms, and in some cases has un- 
equivocally accelerated the fatal event, owing I presume to 
its debilitating effects, increasing the disposition of the lar 



1U8 

to spasm from the irritation of the extraneous substance at- 
tached to, and confined in it. 

It lias been ray constant practice for several years, soon 
after the first bleeding to prescribe an active emetic, most 
commonly a solution of tartarized antimony in water, and as 
soon as it has done operating, to apply leeches to the whole 
anterior part of the trachea, followed soon after the operation 
of the leeches by a blistering plaster, across the trachea, and 
over part of the thorax and fauces, And after the second 
bleeding, which I always found most beneficial when employ- 
ed during the exacerbation of the paroxysm, I have generally 
made it a rule to repeat the blister to the trachea, and one to 
each wrist and ancle at the same time.* 

As soon as the patient has rested sufficiently from the fa- 
tiguing operation of the emetic, I have for many years pre- 
scribed calomel to be taken in doses of from one to four or 
five grains according to the age of the patient, every hour, 
mixed in a spoon with some agreeable syrup or preserve, till 
all the violent and distressing symptoms were subdued, or till 
increasing debility and symptoms of suffocation, or convulsive 
motions gave the signal to desist* 



* Drs. Ferriar and Cheyne speak favourably of immersion in the warm 
bath, after the operation of an emetic, and from a few cases in which I 
have seen it employed after the blood-vessels have been freely emptied, im- 
mediately after the operation of an emetic, I think it an excellent auxiliary 
in such circumstances ; it determines the circulation to the surface, and 
thereby withdraws its force from the inflamed part, but from its usual ef- 
fects in first increasing 1 the fulness of the pulse it must be an equivocal re- 
medy before the sanguiferous system has been copiously emptied by vene- 
section. 

As soon as the bath has had the effect of inducing perspiration, blistering 1 
the limbs have a most evidently beneficial effect in preventing the circula- 
ting fluids from being again morbidly determined to the inflamed trachea. 



nploycd as ;i remedy in ihla di 
, the malignant ore throat by icveraJ American phj 
.ind particularl) b) the late Dr.Tliomaa Bond, aa earl] 
, to mj knowledge, and was first tried in the 
nanche maligna by Dr. Douglass of Boston, and l>y Governor 
in and Dr. Ogden of NVv. -York, %< ry early iii the eigh- 
th century, but I do not know what physician first employ - 
ed it in the croup, or by what circumstance or train of reason* 
:dto make trial of it. 

soon as the violence of the disease is evidently abated, 
the calomel is to be gradually discontinued, allowing at first 
two, then three, and finally four or five hours to intervene be- 
tween each dose, according as the symptoms are more or less 
completely subdued. Calomel given in' this manner com- 
monly occasions both vomiting and purging, and the first al- 
leviation of the symptoms is generally observed to follow a 
discharge of a large quantity of dark green coloured matter. 

The doses of calomel should be regulated principally by 
the age of the little sufferer. When under one year OI a g e 
it may be given from one to two grains every hour ; from one 
to two years it may be given from two to three grains ; du- 
ring the third and fourth years it may be given from three 
to four grains, and during the fifth and sixth year from four 
to five grains, and so on. The calomel should always be 
mixed with some thick substance in a spoon when given, 
and never in any thin liquid. 

I have frequently employed emetics alter I had reason to 
conclude that the membranous substance was formed which 
constitutes and characterises the second stage of the disease, 
with an expectation of detaching and forcing it out of the 
trachea, but in no instance with success, but in some cases 
manifest injun-; whereas I have seen a few cases in 



iio 

which the membrane has been brought: up by coughing after 
mercury had been freely employed; being detached it is pre- 
sumed by the mercury having increased the power of the ab- 
sorbents. 

It is in this stage of the disease, when the hoarse cough, 
croaking voice, irregular respiration, and sudden fits of appa- 
rent suffocation which come on after short intervals, are occa- 
sioned principally by the membranous substance formed in 
the trachea, and which dissections shew is. firmly attached to 
it a little way below the glottis, that a strong decoction of 
radix seneka, so much extolled by several physicians of emi- 
nence in the middle states, and particularly by Dr. Archer of 
Maryland, as a remedy of superior efficacy in this disease, 
becomes a useful auxiliary to mercury, in consequence of the 
irritation it gives the fauces and the cough it excites, which 
when it is loosened or nearly detached by the action of the 
mercury, forces it up and rescues the patient from all danger 
of suffocation ; but from its irritating quality and effect in ex- 
citing cough it is highly improper to administer it in the early 
or inflammatory period of the disease, as it increases the flow 
of blood to the inflamed trachea, and every thing that has 
that effect must necessarily aggravate the disease. 

Dr. Smith of Loudon county in the state of Virginia, in 
a communication published in the fourth volume of the Phi- 
ladelphia Medical Museum, relates that he had employed 
blood-letting in several cases of croup without success, and 
that in some it appeared to increase the dangerous symptoms 
and rendered the disease fatal ; but from the success which I 
have frequently had with the lancet, when employed within 
the first twenty and especially when employed within the first 
twelve hours from its commencement, and so copiously as to 
induce sickness at stomach and symptoms of fainting or of 



111 

approaching- convulsion"?, as well as from the testimony whicl 
lias been adduced in its favour by several physicians of i 
blished character both in Europe and America, and particu- 
larly bj Drs. Il'inn-, Cullen, Ferriar, and Cheyne, in (ireat- 
llritain, and 1>\ Dr. E. C. Dick, of Alexandria iti Virginia, 
I nm convinced that Dr. Smith did not employ the remedy 
i arty enough or was too sparing iii the quantity of Mood which 
he drew from his patients. 

Dr. Home, the author of many valuable experiments with 
different articles of the materia medica in various diseases, 
ordered no less than five ounces of blood to be taken from a 
child fifteen months old, labouring under the cynanche tra- 
chealis. 

The pulse still remaining hard, he ordered a repetition of 
the bleeding to the same quantity on the same day. On the 
following day he ordered the child to be bled largely by 
leeches, and these repeated evacuations were followed by the 
recovery of the* child. 

Dr. Ferriar of Manchester in the third volume of his Cases' 
and Reflections attributes his success principally to his draw 
mg blood on the first appearance of the symptoms which cha- 
racterize the disease, and to his taking away at once as much 
as the patient could bear without fainting. 

Dr. Cheyne, who has written still later on this disease, gives 
testimony in favour of early and copious bleeding. And 
Dr. Dick in a letter addressed to Dr. Barton, professor of 
materia niedica and natural history in the University of Penn- 
sylvania, whose talents and ingenious researches entitle him 
to rank among the first scientific characters of the present 
a^e, published in the third supplement to the Fhiladel- 



112 

phia Medical and Physical Journal, assures him that he had 
succeeded in a very large majority of the cases of croup 
which had come under his direction, and the number that 
occurred in Alexandria was very great in the autumn 
of the year 1799, and the winter of 1800, by early and 
copious venesection, followed immediately after the ope- 
ration by a dose of calomel. His patients were bled during 
the exacerbation of the first paroxysm while held or propped 
up in an erect posture, and the blood suffered to flow till signs 
of fainting began to come on, w T hen they were immediately 
laid on a bed or mattress, and as soon as recovered from the 
debilitating effects of the bleeding the calomel was adminis- 
tered. He found the same treatment succeed equally well in 
the second paroxysm in cases that had remitted in the morn- 
ing after the first paroxysm, in consequence of which remis- 
sion the lancet had not been employed. 

The cases in which blood-letting failed with Dr. Dick, were 
those where either the second paroxysm was suffered to pro- 
gress during the night, or when the first paroxysm having 
undergone little or no remission in the morning, was permit- 
ted to proceed without interruption to the begimiing of the 
second night. 

Dr. Dick adds that in two or three instances only during 
the winter that the croup was so remarkably prevalent at 
Alexandria, a return of the disease some hours after its re- 
moval by bleeding, ad deliquium y obliged him to repeat the 
remedy to the same extent as at first, and that in those cases 
it was alike effectual in affording immediate relief; and he 
had in no instance occasion to resort to it a third time. 

Dr. Kuhn informs me that in his practice he has frequently 
found the early application of leeches and blisters supercede 
the necessity of very copious bleedings by the lancet, 



If* 

B has been pn i 

rate i this disease by ph; minence, and 

particularly by Dr. Huxham, (in his Observations on the v - 
and Diseases of the Year 1739, vol. EI. p. 22), and by Dr. 
Francis Home, the writer who by his experimental tnqui- 

lirst ascertained the inflammatory nature of thi 

re which it was either treated empirically or erroneously 

and destructively, from a supposition that it was a spasmodic 
affection of the glottis. But Drs. Crawford, Ferriar and 
Clnvnc, disapprove of the operation, from an apprehension 
that during the attempt to extract the preternatural extrane- 
ous substance, the artificial passage made for the air as well 
as the passage by the glottis should be obstructed and the 
patient suffocated. 

In situations where leeches cannot be procured, the skin 
over the upper part of the trachea may be taken up between 
the thumb and finger of one hand, and several small incisi- 
ons made into it with a lancet or scalpel, after which cupping 
glasses from which the air has been expelled, or rarified by 
burning pieces of paper dipped in rectified spirits of wine or 
proof brandy in them, or by holding them over the flame of 
a lamp, should be applied to the incisions. But if neither 
cupping glasses nor leeches can be procured, the glasses used 
for drawing milk out of women's breasts, which have a bowl 
of a cylindrical shape, and a long curved handle, may be em- 
ployed as a substitute for cupping glasses. By applying the 
howl of this to the orifices a sufficient quantity of blood may 
be drawn by a person sucking the end of the tube. 

If the little sufferers could be prevailed on to let cup- 
ping glasses be applied to the orifices first made by leeches, 
the blood drawn by those means would in the less violent 
supercede the necessity of such copious bleeding from 






114 

the arm as has been so earnestly recommended. The diffi- 
culty of bleeding a restless child in this disease from the 
jugular veins, has deterred me from recommending the open- 
ing of them. 

The regimen in this disease during the existence of the 
local inflammation, should be the same as that recommend- 
ed by the most experienced writers in other inflammatory 
afFections of a highly dangerous tendency. 



OF THE 

PERIPNEUMONY, 

OR 

INFLAMMATION OF THE LUNGS, 



Peripneumony or inflammation of the lungs is denoted 
by acute fever, with the face of a livid colour, and somewhat 
swelled, difficult respiration, obtuse pain in the anterior and 
superior portion of the thorax, a cough usually moist and 
frequently bloody. It begins with the common symptoms 
of fever, though the pulse may be perhaps but little quick- 
ened or the heat of the body much increased, and there pre- 
vails more a sense of weight than pain in the seat of the 
affection. The breathing is most impeded in inspiration, and 
when lying on either side. The cough is at first attended 
with thin gluey expectoration, but becomes, in the progress 



of t; ire thick and cop 

, i hcd up ■• 
with blood. The pulse is t ost part soft, 

inguishes it from pleu d in die 

advaiM weak and often irregular. 

use fibre and sanguine constitution are most 

the attacks of this disease, which are most frequent 

at the middle period of life | for neither youth nor old age are 

Qon subjects. It prevails chiefly in winter and 

tack favours a repetition of the malady, 

Its causes may be referred to cold operating upon the 
Is of the bronchiae and lungs. 

This disease sometimes obtains a favourable termination by 
nlaneous haemorrhage from the nose ; the expectoration 
of thick yellow coloured mucus brought up without much dif- 
ficulty, a critical sweat, the deposition of a brick coloured sedi- 
ment in the urine, and sometimes, which is more rare, the 
appearance of an erysipelas on some external part; from 
which period the symptoms remit. 

Our prediction of the event is to be governed by the state 
of the symptoms, as the degree of fever, which, when -at- 
tended with delirium, is always highly dangerous ; the diffi- 
culty or ease of respiration, which denotes hazard when it 
can be performed only when in an erect posture, and the 
greater or less violence of the cough, which is most favoura- 
ble when moist, and the phlegm easily expectorated; yet this 
disease is often highly deceitful in its symptoms, and with a 
form apparently mild and little alarming, it proceeds rapidly 
to a fatal and unlooked-for issue ; particularly in low, w r et 
situations, and open rainy winters. Hence the slightest ap- 
pearance of it should always be considered as important 



116 

Like most other inflammations this disease either terminates 
by resolution, effusion, suppuration or gangrene. "When it 
terminates by resolution it generally takes place in the first 
week of the disease, especially if moderate in its symptoms, 
though it is liable from the third to the seventh day to a de- 
ceitful remission, which is followed by an exacerbation. This 
resolution is marked by one or other of the discharges al- 
ready mentioned. 

Suppuration is always to be suspected if the fever and 
pain are protracted beyond the fourteenth day. The exist- 
ence of this is denoted by slight chills or rigours with a full- 
ness of the pulse and an increased quickness every evening. 
Or lastly, which is peculiar to this disease, (and when it oc- 
curs is always fatal), by an effusion into the cellular mem- 
brane of the lungs, producing 'suffocation, which happens 
generally from the third to the seventh day ; this effusion 
may sometimes be connected with gangrene. The disease 
has been mentioned, at times, as liable to a metastasis to the 
head or abdominal viscera; but these are rare terminations. 

TREATMENT. 

In the treatment of this disease more than of any other 
inflammation, excepting that of the brain, stomach, heart 
or diaphragm, an early application of the antiphlogistic plan 
in its most rigorous extent, should be made ; and that, though 
the apparent mildness of the symptoms, should appear to 
render such severe treatment unnecessary. 

Bleeding should be had recourse to as early as possible 
in the complaint, and the blood permitted to flow, till sen- 
sible relief of the pain and oppression in the thorax is 
obtained, or to the extent of inducing syncope or fainting, 
and repeated on the same day in an equal quantity, without 



( 17 

if the respiration and paw 
not gi i d.* 

Aft end bleeding, topical bleeding b of cup- 

dt the same view, if indicated by the i 

tinua turn of d and pain; And blisters may be 

I . and advantageously applied to the thorax and legs im- 
i ond bleeding and the operation of an 
thartic. 

Sydenham and most practical writers before the publica- 

- alien's first lines, prohibited the use of the lan- 

ifter the patient began to expectorate thick and coloured 

. and others limit it to the first five days of the disease ; 

lations which ought by no means to be adopted, the only 

rule for discontinuing blood-letting being relief from pain 

ad difficulty of breathing. 

The remainder of the treatment in common cases of perip- 
neumony corresponds in every respect with that recommend- 
ed in the pleurisy, which folio ws.f 

* So long as any pungent or shooting- pains remain there is an infallible 
indication for bleeding. 

I).- Dover asserts that his next door neighbour "had a servant seized 
with pleurisy, who lost two hundred and sixty ounces of blood before his 
pain left him," and that he afterwards enjoyed perfect health. — Physicians 
Legacy, edit. 8th, p. 33. 

In the year 1801 Mr. Hughes, a cabinet maker, about forty years of age, 
lost two hundred and eight ounces by my direction in six days, before the 
pain and oppression of his thorax were removed, after which he recovered 
very rapidly. 

f Dr. Kuhn, one of die best informed and most judicious physicians that 
America ever gave birth to, informs me that he has met with a state of 
pneumonia extremely distressing and highly dangerous ; in which after the 
inflammatory symptoms had been subdued, considerable oppression remain- 
ed, with inability to expectorate ; and that under these circumstances he 
had found the volatile alkali a powerful expectorant. 



118 



OF THE PLEURISY, 



OR 



INFLAMMATION OF THE PLEURA, OR ME M 
BRANE SURROUNDING THE LUNGS. 



This disease, like the other genera of the second order, 
begins with a cold stage, but differs from the peripneumony 
in the seat and acuteness of the pain, and in the hardness and 
frequency of the pulse ; its pathognomonic or characteristic 
symptoms being acute and pungent pain in one side of the 
thorax, most frequently the right, augmented chiefly during 
the time of inspiration, -with an increase of pain rvhen lying 
on the affected side in ths early part of the complaint, but the 
reverse at a late period if suppuration has taken place. A 
most painful cough, dry in the beginning of the disease, af- 
terwards an expectoration of phlegm, most commonly of a 
light brown colour, and tinged with blood. The pulse being 
at the same time tense or hard, quick and strong. 

The cough and stitch always precede the fever, and not 
the fever the local inflammation, which from the fever cea- 
sing with the cessation of the pain proves it to be merely: 
symptomatic. 



119 

The Inflammation of the pleura -lv extends to the 

diaphragm which i-, distinguished by the respiration being 
performed only by elevating the ribs and in an erect posture. 

In Philadelphia when the disease terminates fatally, it is 
rally between the seventh and fourteenth clay, most fre- 
quently onth. . On the low grounds in the southern 
S it generally finishes its course at an earlier period. 

When it terminates favourably it is generally on the fifth, 
nth; eighth or ninth day, for it does not seem to pay 
much respect to Ilippocrates's critical days ; but it sometimes 
terminates favourably after the eleventh day. 

When the pain in the side and fever continue without any 
considerable abatement longer than seven days, it affords rea 
son to suspect that it will terminate in suppuration. And if 
those symptoms continue till tl ' enth day an abscess 

may certainly be expected. 

The signs which indicate that an effusion is mad? which 
may lay the foundation of an abscess in this disease as well 
as in the peripneumony, are, the difficulty of breathing be- 
coming greater and the cough more dry and frequent, when 
the patient lies in an horizontal posture, or when he can lie 
most easily on the affected side, while the feverish symptoms 
which had subsided, return, and arc increased every after- 
noon. "While the abscess is forming, the patient is frequently 
affected with cold sensations or rigours succeeded by flushes 
of heat, and burning in his hands and feet, resembling the 
symptoms of the hectic, or symptomatic fever of phthisis 
pulmonalis. 









120 



With the formation of pus the pain gradually ceases, 
though the cough and difficulty of breathing continue ; and, 
upon any extraordinary exertion, are increased and aggra- 
vated. 

The feverish symptoms, after the formation of an abscess, 
have exacerbations every evening, and remissions every 
morning ; the remissions being accompanied, in many cases, 
with a profuse diaphoresis. 



TREATMENT. 

The treatment of this disease must proceed upen the same 
principles and rules as those, already laid down, in the treat- 
ment cf peripneumony. 

When in either of these varieties of pneumonic inflamma- 
tion, the pain and difficulty of breathing are reduced by the 
means already directed in peripneumony ; besides the appli- 
cation of a large blister to the part affected and to the ancles, 
it will be of service to give one of the following powders, 
dissolved in lemonade or any agreeable cooling liquid, every 
two hours. 

I£>. Pulv; antimon. tartarisat. grs. iij. 

Pulv. nitri. 3 iij. vel |ss. 

Pulv. gum arabic. sach. alb. ana 5j. m. f. ch. no. viij. 

To gratify the patient, while he sits up in bed in order to 
refresh himself, and prevent ill effects from the stimulus of 
the heat retained in the bed, he may have his face and hands 
frequently washed with vinegar and water of tepid warmth. 



121 

The chamber should also be constantly preserved of a tem- 
perature agreeable to the feeling* of the patient, and the 
drinks should he of an acidulous refrigerating quality; such 
as lemonade, tamarind water, apple water, quinee tea, currant 
jelly and water, barberry jelly and barley water, linseed tea, 
balsa water, toast and water, &c. &c. 

The diet should consist entirely of a decoction of barley 
and raisins in water, to which may be added, on account of 
the cough, gum arabic and sugar; oatmeal gruel, panada 
made without die addition of wine or spices, buttermilk and 
water, rennet whey, the juices of oranges, &c. &c. 

Medicines, usually called expectorants, consisting of oily 
mixtures, spermaceti, and syrups, were formerly much cm- 
ployed in these diseases, with an expectation of relieving the 
cough ; but later and more accurate observers have generally 

discarded them as inefficacious and useless, if not injurious. 

t 

The only expectorants to be depended upon in inflamma- 
tory affections of the lungs, or their surrounding membrane, 
are those which reduce immoderate action and the general 
vigour of the system. 

When the inflammation terminates by an effusion into the 
cellular membrane of the lungs, all attempts to relieve, that I 
have hitherto seen attempted, have been of no avail. 

Dr. Darwin, on the subject of pneumonic inflammation, 
vol. i. p. 249, Philadelphia edition, mentions that when the 
patient becomes delirious, and smiles disagreeably at intervals, 

16 



• 



I 



122 

and is become so weak that evacuations by the lancet could 
be no longer made with safety, and he has almost despaired of 
his patient, he has found in two or three instances, that about 
five or six drops of the tinct. opii. given an hour before the 
evening exacerbation, has had the happiest effect and cured his 
patient. When catarrhal symptoms continue after the remo- 
val of the inflammation, 1 have often experienced beneficial 
effects from small doses of Opium. 

"When the inflammation terminates in suppuration, and the 
pus is diffused between the pleura and ribs, it is called an em- 
piema, and can only be relieved by a surgical operation ; the 
manner of performing which, is circumstantially described in 
the second volume of Bell's Surgery, as well as in several 
other modern surgical works. 

When the abscess forms and breaks in the substance of the 
lungs, so that the pus is discharged into the bronchiae, the pa- 
tient frequently recovers by observing a spare diet, and pro- 
moting the discharge of pus, by the frequent use of mild 
emetics and nauseating doses of antimonials, syrup of squills^ 
or a decoction of seneka root and liquorice root. 

In general the same mode of treatment, recommended in 
the phthisis pulmonalis, will be proper in these cases. For a 
more particular direction the reader may, therefore, consult 
the directions, which he will find given for the purpose of re- 
lieving that disease, when it has arrived at its second stage. 

The seneka in decoction^ is highly recommended for the 
peripneumony and pleurisy, which frequently occur in a vio- 
lent and dangerous form, known by the name of the suffoca- 
tion of the lungs, in the southern states, in open winters and in 
low wet situations, 



i etnblance to the pneun 
I l)i (.'ulkii, which is next to be described; foi 
which, I suppose the same treatment, which b a 3 succeeded 
# n the latter, would be equally proper in the former* 

Such i i the Btat* of the system in the generality of those v. 

le in marshy situations in the southern states, especially 
if they have suffered much from intermittent or bilious fevers 
during the autumnal months ; or, have lived long in habits of 

nperance, that when attacked with pleurisy, they seldom 
from it. In such constitutions, the symptoms of two 
diseases of an opposite nature appear to unite with one ano- 
ther. The pain and fever becoming always highest in the 
afternoon, with a diminution of expectoration, and remitting 
in the morning and forenoon, accompanied with an increase 
and copious expectoration of thin gleety, often bloody mu- 
cus. The pulse during the exacerbations of fever is often 
more frequent, but never so strong, full or hard, as in the 
true pleurisy of higher latitudes, and drier situations. And 
the local inflammation is observed to disappear, or to termi- 
nate in effusion and suffocation, much sooner than in persons 
of more vigorous constitutions and phlogistic diathesis; and, 
in many cases, after the disappearance of all the inflammatory 
symptoms, particularly in intemperate livers, the fever still 
continues in the form of typhus mitior, or a slow nervous 
fever, and in other descriptions in the form of an intermit- 
tent, accompanied with bilious evacuations. 

As this disease requires precisely the same |pmedies, and 
method of treatment as the pneumonia notha, the reader is 
,-eferred to that disease, for what should follow here. 



124 



OF THE 

PNEUMONIA NOTHA, 

OR 

SPURIOUS INFLAMMATION OF THE LUNGS. 



This appears to be a species of peripneumony diversified 
in symptoms by constitution and season ; being most preva- 
lent in marshy districts and in open wet winters. 

It commonly begins with symptoms resembling a very se- 
vere catarrh, but with more pain and oppression in the an- 
terior part of the thorax, and much greater difficulty of 
breathing ; and in marshy situations and southern climates 
is accompanied with remarkable debility of the vital and 
animal powers. 

The cough is among the first symptoms, accompanied with 
^ very copious expectoration of viscid mucus of various 
colours, frequently mixed with blood. 

A catarrh is strictly an affection of the mucous membrane 
and follicles of the bronchise alone ; but it may readily have 
and frequently has a degree of pneumonic inflammation joined 
to it, which is the precise state of the pneumonia which occurs 
early in the winter in the marshy situations of the southern 



125 

I tate oftkM MR cted pan , am 

the C4 llular texture of the limgl Buy readily ti»k<- pi 
and occasion a fatal suffocation. The lubjl 
arc generally old or infirm p< rsons, or those who have b 
debilitated l>\ previous disease, and partkularh bj the ■oaer- 

mittcnt i« * have had frequent opportunities of obser- 

ving. Tin- occasions] causes of this di the sanv 

those which produce pleurisy, but the predisposing ones, and 
i tally the diathesis, present at the time of exposure to the 

ry different. Hence the difference in 

TREATMENT. 

When the fever, catarrhal and pneumonic symptoms are 
considerable, early blood-letting proportioned to the age, 
strength and constitution of the patient, has generally afford- 
ed immediate relief; but if symptoms of general debility 
are prevalent, which is often the case, it will seldom be re- 
ite to repeat it, and when an effusion appears to have 
taken place a repetition of blood-letting might prove injurious. 
In all cases the remedies chiefly to be depended on are local 
bleedings by means of cupping glasses or leeches, emetics, 
mercurial purges and blisters. An active emetic, or a mer- 
curial purge should be given soon after bleeding, and when 
they have done operating, a decoction of scneka and the 
oxymel of squills should be taken as directed in the latter stage 
of pleurisy, or rather small nauseating doses of ipecacuanha ; 
large blisters should be applied at the same time to the 
thorax, wrists and legs. If the debility increases, the oppression 
continues, and the expectoration is diminished, sal. alk. vol. 
made into boluses, with conserve of roses or sugar and 
powdered gum arabic, or into a julep with the addition of 
Jose containing five or ?ix grains of sal. alk. vol 



126 

should also be frequently administered, and blisters applied 
to the thorax and wrists, and strong sinapisms to the feet, re- 
newing them occasionally as their effects go off. 

When combined with bilious remittent fever, which is a 
frequent occurrence in the latter end of autumn and begin- 
ning of winter in the southern states, as soon as the inflam- 
matory symptoms have been reduced by the means recom- 
mended ; decoctions of bark and serpentaria will be advisable 
during the apyrexia, with wine whey and mild nourishment 
of easy digestion. 



OF GASTRITIS, 

OR 

INFLAMMATION OF THE STOMACH, 



This disease is distinguished by acute fixed pain and burn^ 
ing sensation in the stomach, aggravated by every thing taken 
into it, and by motion and pressure. 

The pulse after the cessation of the rigors with which it 
commences is hard, contracted, small and frequent, and is ac- 
companied with great anxiety, oppression, and greater dimi- 
nution of strength than in any other inflammatory affection. 



ry thing taken into the stomach occasions votn 
w kill painful straining, Hio up >* rally an early symp- 

tom. The f< and muscles of th ted 

and shrunk, and socm appear to be remai red. 

Hiia is divided by systematic writera into 

>noua and ery ripelatous. But as the latter,, 
only die sequel <>l" other di and 

aring towards their termination when fatal, 1 shall con- 
rvations to the former. 

The most usual causes of this disease arc, large draughts 

,ld drinks, such as a large draught of cold water, iced 

punch or iced creams, taken when the patient is in a profuse 

perspiration, at a time when the body is rapidly parting with 

its heat. 

It is also sometimes occasioned by contusion or distension 
from swallowing hard and indigestible substances and by poi- 
sons or corrosive substances, &c. 

Its termination, like the diseases of this order, is bv reso- 
lution, suppuration or gangrene, and in some instances b\ 
schirrus. 

Our prognostic of the event must in general be unfavoura- 
ble. If the pain, vomiting and fever are not manifestly relie- 
ved in the course of four days, we may expect suppuration 
or gangrene to take place. 

The former is distinguished by frequent, transient rigors* 
.md flushings of heat, with a remission of the acute pain, 
seeded by a sense of weight and distension. 



128 

In this case the pus is sometimes discharged by vomiting 
or diarrhoea, and the ulcer heals. This however is not often 
the case. 

Gangrene is distinguished by the sudden cessation of pain 
and fever, cadaverous coldness of the extremities, livid co- 
lour and fullness of the face, and by a vomiting or purging of 
dark or black coloured matter, mixed with small flaky sub- 
stances, resembling coffee-grounds, &C* 

When the inflammation terminates in schirrus, the patient 
Is subjected to a painful and lingering hectic, which after some 
time carries him off. 

TREATMENT. 

As this disease frequently terminates fatally, in the course 
of three or four days, the remedies should be employed as 
early in the disease as possible. The most effectual remedies, 
are copious and repeated bleeding without regard to the state 
of the pulse ; provided, the pain is acute, as the pulse almost 
invariably rises and becomes fuller after the first or second 
operation. 

As purgatives cannot be taken into the stomach with safety, 
mild laxative clysters should be injected every three or four 
hours, as long as the violence of the pain and hardness of the 
pulse continue. 



* For the appearances of the stomach after death, consult Dr. Stark's 
Clinical and Anatomical Observations 



acidulated v »uld also be 

ii into the mouth almost Constantly, and swallowed h i- 

turel] ; and) after the Becond bleeding, which should kx 

large aa the patient can bear without swooning, followed by 

< tipping, or the application of leech* tonmoh ; an epis- 

enough to cover the stomach and hall' the alxlo- 

. with two at the same time to the legs should be applied, 

and afterwards dressed with simple cerate. If die stomach 

ery kind of drink, the patient must content himself 

with holding lemon or orange juice and water, or tamarinds 

in his mouth without swallowing them, and persevere in the use 

i laxative clysters and the use of the lancet, till the stomach 

will bear barley water, or a decoction of toasted oats and 

gum arabic, thin sago, or arrow root, &c. 

If the disease terminates in suppuration, a spare cooling 

diet, and demulcent drinks with an occasional clyster, or a 

mixture of oleum ricini, and a mucilage of gum arabic, should 

times be given to favour the discharge of the pus. Erne- 

would be unsafe. AVhen it terminates in gangrene all 

to arrest the progress of death are unavailing. 



130 



OF ENTERITIS; 



OR 



INFLAMMATION OF 'THE INTESTINES. 



The existence of this inflammation may be known by a 
constant and fixed pain in the abdomen, particularly about the 
umbilicus, attended with fever, a hard and frequent, though 
generally small pulse, costiveness,* and frequent vomiting, or 
efforts to vomit. 

One of the most certain signs of the disease being an in- 
flammation of the intestines is, that the pain is greatly in- 
creased upon taking any thing warm into the stomach, 
whereas, hot and stimulating substances, generally afford 
ease in cases of colic. The tongue is also white and dry in 
enteritis, and the countenance betrays great inward distress 
and anxiety, and the thirst is excessive. 

Gangrene, which is the most frequent termination of en- 
teritis, often supervenes in the course of three or four days. 
The chief symptoms of gangrene are, a sudden cessation of 
pain, sinking of the pulse, shrinking of the features, disten- 
sion of the belly, deadly coldness of the limbs, and cold, 
clammy sweats. 

■♦ 
* When the enteritis is of the erythematous kind, it Is accompanied witji 

n painful diarrhoea and little or no vomiting. — Culkn's Nosology. 



Ti. .>iv much the of the 

other genera and specie*, of phi 

Our judgment or prediction ol tiu 1 event <>l thii 
must always be uncertain. Unless the sympti vidently 

alleviated in three ot tour days at farthest it generally pro 
fatal. Our judgment of the event is therefore chiefly to be 
directed by the violence and fixed state of the pain, for if re- 
mitting and shifting in its situation it is then to be considered 

<mcwhat favourable, and particularly if the symptoms of 
become at the same time milder. The occurrence of 

igury, when not the consequence of blisters is very ge- 
nerally a dangerous symptom. Dissections in this disease 
shew mortification of the intestines often to a considerable 

'it. Their outer surface covered with red vessels, their 
inner surface when cut into gangrenous. The peritoneum is 
idso more or less affected and covered at times with a layer 
of coagulable lymph. The intestine is often of a dark colour 
and gangrenous appearance and texture, losing entirely its na- 
tural cohesion. Ulcerations are found in the farther progress 
of the disease in different parts of the intestines, which as- 
sume various appearances. Adhesions likewise of the dis- 
eased portion are formed with the contiguous parts. Ob- 
structions are found frequently in the cavity of the intestines, 
which are greatly distended with air and faeces about the ob- 
structed part, as also sometimes intussusception or inversion 
of one part of die intestine into another, constrictions, con- 
tortions, Sic. &c. 

In that form or species of the disease called the iliac pas- 
, it is always occasioned either by the inversion of a por- 
tion of intestine, or the strangulation of a portion of intestine 
in its passage through the abdominal ring into the scrotum, 
or other aperture leading from the abdomen. Tn which case 



132 

the patient is always affected with excruciating pain and vo- 
miting, and is invincibly costive, till the complaint is removed 
by reducing the incarcerated portion of the intestine to its 
natural situation. 

TREATMENT. 

No disease requires a more strict employment of the anti- 
phlogistic regimen than the enteritis, and there is no one in 
which an inexperienced practitioner is more apt to be decei- 
ved with respect to the expediency of employing this regi- 
men. In the beginning the pulse is hard and frequent, but 
low and small, the feet are generally cold and the patient com- 
plains of cold sensations upon every change of posture ; 
hence the inflammation is not always suspected, but the pain 
is ascribed to flatus or indigestion. 

Tfjhe pathognomonic symptoms, or those which distinguish 
se from every other of the same order, are a fixed 
Sstant pain in the abdomen, particularly about the um- 
bilicus, accompanied with fever, costiveness, sickness and 
vomiting. 

In the sickness, hardness and irregularity of the pulse, it 
agrees with gastritis. 

In the cure of this disease, large and repeated bleedings 
from the arm and by the application of leeches or cups to the 
abdomen, are the most effectual remedies. There are some 
instances on record where two hundred ounces of blood 
have been drawn, in the space of five days before the inflam- 
mation was subdued.*' 

; - S^c Yanswieteii's Commentaries. 



i tain kinds of pui also Iwrn supposed highly 

beneficial. Of these Dr. Hcberden and Sir John Pringle h 
n the preference to epsom salts (raagnes \itii<>lata) and 
ct them lobe taken in the following manner: two ounces 
of the hitter purging salt (sulphate of tnagm sia) commonly 
called epsom salt, is to be dissolved in one pint of boiling 
water, and two table spoonfulls to be taken every half hour, 
or one table spoonful! at shorter intervals, as long as the pa- 
tient's stomach will hear it, or till it occasions his bowels to 
be freel) itedj after which it is to be repeated at 

longer intervals, till the inflammatory symptoms give way. 
Notwithstanding the unpalatableness of this medicine, the 
stomach will frequently retain it when it rejects medicines 
and drinks that are more palatable. 

Mild mucilaginous and oily clysters, administered rather 
cool than warm, and in small quantity at a time, 2nd fre- 
quently repeated will greatly facilitate the operation of the 
purgatives. 

In this dangerous disease a large blister should always be 
applied over the abdomen as soon as the hardness and ten- 
sion of the pulse has been reduced by general and local blood- 
letting. When this begins to heal, and the disease still ex- 
ists, the same remedies should be repeated with the addition 
of blisters to the inside of the thighs or legs. 

The same drinks and regimen should be employed as di- 
rected for the gastritis. 

Mercurial cathartics are recommended by Dr. A. P. Wil- 

, a late writer on this disease, as well as by Dr. Pember- 

ton ; but from their stimulating operation, I should think them 

hazardous remedies. The oleum ricini is much milder and 

frequently very efficacious in evacuating the intestines. 



J $4 

Notwithstanding the high estimation in which Drs. Heber- 
den and Pringle are deservedly held, I am of opinion that 
they have been deceived with respect to the effects of saline 
purgatives in this disease ; as the stimulating action of every 
kind of purgative must necessarily increase the inflammation 
after it is once formed ; but as the retained faeces aggravate 
the inflammation more perhaps than the stimulus of some 
purgatives, this circumstance ought to be always attended to 
and the faeces discharged by mild oily laxatives, or by mild 
injections. 



OF THE HEPATITIS, 

OR 

INFLAMMATION OF THE LIVER. 



The diagnostic symptoms of the acute hepatitis, are, a pain 
more or less acute in the right hypochondrium, increased by 
pressing on the part ; considerable pyrexia, with a frequent, 
strong and hard pulse. 

It is chiefly distinguished from pleurisy by there being less 
cough and less dyspnoea, and particularly by the patient being 
able to lie with most ease on the affected side, which is the 
reverse in the first stage of pleurisy. The pain in this dis- 
ease is often extended to the clavicle and to the top of the 



shoulder md is attended sometimes with hiccup, and some- 
times with vomitii 

\\ lu n the ( part of th< liver is inflamed there is u 

ted pain in the right hypochondrium, with inflation, 
on and hiccup. When the convex part is inflamed there 
evident and painful enlargement of the side, with acute 
pain in breathing, extending up to the neck or top of tin- 
right shoulder, accompanied with adry cough. 

\\ hen the convex part of the liver is affected, the patient 
sometimes can only lie upon the left side." 

" The disease of the liver has a great tendency to suppu- 
ration. AY hen suppuration occurs and the abscess points out- 
wards, and the matter is discharged by incision, the patient 
has some chance of recovery ; but when it bursts within the 
f the abdomen or into that of the thorax, the case al- 
most always proves fatal. Sometimes, however, such dan- 
gerous cases terminate favourably."— (See Clark's Diseases 
of long Voyages, vol. II. p. 404.) 

It is often difficult to distinguish this disease from an in- 
flammation within the thorax. In most cases, however, it 
may be distinguished by the circumstances of the cough ha- 
ving succeeded and not preceded or been coeval with the pain 
and fever, and from the pain being increased by gentle pres- 
sure under the margin of the ribs of the right side, and from 
the patient being able to lie with most ease on the affected 
side in hepatitis, whereas in pleurisy or inflammation of the 
thoracic viscera, he lies with most ease on the side that is 

t affected. This is an important f :'c+ w! 
be retained in memorv. 



136 



TREATMENT. 

This disease requires precisely the same remedies as the 
pleurisy, with the addition of topical blood-letting by mean? 
of cupping glasses or leeches. 

Physicians who have practised in the East-Indies, where 
the disease is said to be very common, speak highly in favour 
of the use of mercury in it when the pain continues after the 
mitigation of the inflammatory symptoms. 

Mr. Benjamin Bell in his system of surgery advises the* 
adoption of a similar mode of treatment. 

Drs. Clark and Hamilton in Great-Britain affirm that mer- 
cury rubbed into the side and taken internally in such quan- 
tities as to occasion tender gums, scarcely ever fails of re* 
moving the complaint. This remedy has not been so suc- 
cessful in Philadelphia, and when it is of service in the acute 
form of the disease, it appears to be so only when it operates 
as a purgative, and not when it operates by inducing saliva- 
tion; but in protracted or chronic cases a salivation is the 
remedy which has succeeded more certainly than any other. 

Dr. Clark says, when cases resist the common antiphlo- 
gistic mode of treatment, mercury should be prescribed from 
the fourth or fifth day of the disease (the phlogistic diathesis 
being by that time generally reduced.) His prescription is 
two grains of calomel made into a bolus with conserv. rosar. 
twiee a day, with an opiate in the night-dose to prevent its run- 
ning off by stool : as soon as the mouth became affected the 
medicine was omitted, and although a salivation was not ex- 
cited, yet in all the rases the cure was completed in a fort- 



it or three weeks. During thi i piration 

■me difficult or the pun in the side more violent, it \ 
necessar} to bleed and to apply i blister to the part affected* 
( lark on Diseases of Hot Climates, vol. II. p. 410, edit 2. 

Dr. (Mark adds that he has found mercury so successful in 
subduing a multitude of diseases of very different and oppo- 
that he cannot impute its efficacy to one quality 
Perhaps its chief excellency depends upon its indu- 
j and supporting a condition or state of the system op- 
• that of the existing disease. Dr. Girdlestone saws, 
u mercury always succeeded best in the East Indies when 
applied externally from 3ss. to 5j. twice a day." But in the 
cases which have occurred in my practice in Philadelphia, I 
have alwavs thought the mercury produced the most certain 
t when it operated by stool, provided its evacuating ef- 
fects were not so profuse as to exhaust the patients strength 
too much. 

The natural tendency of inflammation of the liver is to 
suppurate, and when the inflammation is on the convex or 
external surface of the liver the abscess frequently finds vent 
externally in consequence of the adhesion produced by the 
inflammation between the liver and the peritoneum. 

In such cases the abscess should be opened with a lancet 
as soon as the softness of the tumour or fluctuation of mat- 
ter is evident. 

The quantity of pus which sometimes issues from those 
abscesses is almost incredible. When suppuration occurs in 
the concave portion of the liver the pus sometimes by a simi- 
lar adhesion of parts in consequence of the inflammation, 
finds its way into the intestines and is gradually evacuated. 

18 



133 

But when the pus finds no vent or an insufficient one a hec- 
tic ensues, which sooner or later puts a period to the patient's 
life. 

Dr. C. R. Pemberton, in his " Practical Treatise on vari- 
ous Diseases of the Abdominal Viscera," objects to the use 
of mercury in the acute form of hepatitis, except when given 
in a large dose as a purgative, because of its tendency to in- 
crease the general phlogistic diathesis and increase the force 
of the circulation before it produces ptyalism. The external 
application of the blue ointment is liable to the same objec- 
tion* 

Dr. Pemberton places his chief dependence upon the sud* 
den and repeated abstraction of a large quantity of blood 
from the arm and from the affected part by means of cups or 
leeches, and one free purging daily by means of a solution of 
epsom salts in a strong infusion of senna. This may be ren- 
dered palatable by the addition of chrystals of tartar, tama- 
rinds or lime-juice and sugar, and after it has operated very 
copiously it may be given in reduced doses once in four 
or six hours, so as to keep up a frequent evacuation, pur- 
ging in this disease being particularly useful, as by increasing 
the secretions of the intestines it withdraws the determina- 
tion of the blood from the vena portarum, and thereby pre- 
vents it from distending the inflamed viscus. 

When, after the judicious application of the recited reme- 
dies, the pain still continues though more obtuse, a large epis- 
pastic should be applied over the hepatic region, and occasion- 
ally renewed as it shews a tendency to heal. Under these 
circumstances, nauseating doses of emetics are also advisable^ 
similar to those directed in the treatment of pleurisy. 



• The cii m of tin m the fere itest number 

. is the consequence of a long continued course t>i in- 
temperance in ardent spirits, though it is also Bometimea the 
equence of repeated attaeka of the intermittent fever, and 
other debilitating powers gradually applied* 

Vi This form of hepatitis is discovered by a sense of weight 
and dull pain in the light side, and a weight and weariness in 
the right arm; pain also frequently occurs on the top of the 

shoulder. The tongue is usually whitish, the appetite im- 
paired, and the countenance sallow. The pulse is about 
ninety, and almost invariably intermitting. 

u AVe may account for this intermission, from the blood in 
the hepatic artery, not rinding a ready passage through the 
hardened viscas ; it is, therefore, thrown buck upon the 
heart, and thus interrupts the regular action of that organ. 
There is also very commonly, a sensation of fluttering at the 
pit of the stomach, which may arise from the blood of the 
vena portarum, being in like manner unable to find a free 
passage. It is, therefore, retained in that vein, and causes a 
sensation of undulation* 

" From the want of a free passage of the venous blood, arise 
the haemorrhages which often take place from the stomach, 
intestines, and nose. Pimples are also observed, frequently 
to make their appearance upon the nose, cheeks and forehead. 
The body in this disease becomes much emaciated ; and in 
the advanced stage, a dropsy of the abdomen takes place, by 
'.vhich.the patient is destroyed." 



\40 



TREATMENT. 

In the cure of the chronic form of this disease, the genera- 
lity of physicians give the preference to mercury, which is 
either given in small and repeated doses internally, or applied 
in the form of ointment to the region of the liver externally 
till a salivation is excited, having previously cleared the prima? 
viae with an active cathartic. 

" As dyspeptic symptoms generally accompany the disease, 
it is generally necessary to give the patient some gentle tonic, 
during the use of mercury, and when calomel is employed, a 
small quantity of opium should be joined to eyery dose." 

For a inure detailed aucuunt ot the treatment of this form 
of the disease, the reader mav consult Clark on the diseases 
of long voyages, and those writers that have practised in the 
East Indies, where the chronic inflammation of the liver is a 
very common disease. 

The regimen should be directly the reverse of that which 
favoured the generation of the disease ; and, after the indu- 
ration has been removed, the patients strength may be re- 
stored by a nutritious regimen of easy digestion, the mode- 
rate use of chalybeate waters impregnated with carbonic acid 
gas, moderate and repeated exercise, &c. &c. 



Ml 



OF Tin: RHEUMATISM, 



Tin is most prevalent in the middle states, during 

latter portion of the spring and the early pait of the. 
autumnal - owing to the greater and more frequent 

mperature at those times. 

Tt most frequently attacks persons who change their winter 
clothing too early in the former season, and their summer 
clothing too late in the latter. 

It also frequently occurs in the winter season, particularly 
among the inhabitants of the western and mountainous parts or 
the country, owing to deficiency of warm cloathing; and 
especially among those who, after the fatigues of the day, 
are not sufficiently protected during the night from the impres- 
sion of the severe cold, which frequently prevails at that 
inclement season. 

" Shuddering in the hut of cheerless poverty . 
Sore piere'd by wintry winds 
And Rheum's joint-rucking- pains." 

This disease is accurately described by Dr. Cullen, in the 
second volume of the edition of his First Lines of the Prac- 
tice of Physic, published by Dr. Rotheram with notes in the 
year 1791, and the treatment which he recommends in the 
acute or inflammatory stage of the disease, has been so fre- 
quently confirmed by my own experience, as Dr Fowler's has, 



14£ 

in the chronic stage of the disease, especially when accompa- 
nied in the latter case with the use of mercury either inter- 
nally or externally till its effects were visible in the mouth, 
cold water being applied at the same time by affusion to the 
parts (if seated in the limbs) most affected with pain and 
weakness, followed by friction and the application of warm 
flannel. 

Having therefore no new improvement in the treatment of 
this disease to offer, I shall content myself with referring the 
reader for more ample information to the publications of those 
very excellent and experienced authors, and shall only add 
that the favourable reports of some of the British physicians, 
with respect to the beneficial effects of Dr. Fowler's solution 
of arsenic in cases of chronic rheumatism, has lately been 
confirmed by the experience of Dr. Parke at the Pennsylva- 
nia Hospital, the particulars of which were lately communica- 
ted by him in writing to the College of Physicians. 



OF THE GOUT, 



The best description of this offspring of indolence and glut- 
tony that I have met with is contained in Dr. Cullen's First Lines 
of the Practice of Physic, vol. 4th; to which to save the trouble 
of transcribing, the reader is referred. Several authors have 
written professedly on this subject, particularly Mr. Warner 



and i ei * Kail therefore only 

that it is distinguished from the rheumatism by being pr< 

roptoms of indij id me paint bemg seated in 

the smaller joints, and that as it depends on causes which 

powers of tin bod} , it can m 
..IK cured by medicines alone, whose effects are alu 
j and often inefficacious, while the remote con* 

tinuc to be applied. 

It must therefore be obvious that however useful pallia- 
mav be during the paroxysm, temperance and a due de- 
se must be the principal means of preventing its 
•ecurrence. 

In the case of Dr. Darwin, a course of temperance, cxer- 
rise and regularity, entirely removed the disease. For 
iculars, the secon^Pvolume of his Zoonomia may be 
consulted. 

The cure of the gout has been attempted of late years, by 
means of depleting remedies and the application of cold 
water to the affected parts, during the exacerbation of the 
painful and feverish symptoms, by several enterprising phy- 
sicians in different parts of Great Britain, and particularly by 
a very zealous practitioner by the name of Kinglake. 

To render this treatment safe as well as effectual, Mr. B. 
M ntal of Bromley, advises strict attention to the following 
rules. 

u 1st, Never to begin with the cold applications till the in- 
ternal viscera have discovered indubitable signs of performing 
their proper functions with accustomed energy, which will 
rarely be the case till the local inflammation has existed for 



144 

some hours, and often for two or three days, and in some 
cases even a longer period. 

2d, When these signs are discovered, and leave no doubt of 
the existence and establishment of inflammatory action accom- 
panied with general vigour in the circulating system, the ap- 
plication of cold water to the affected part is perfectly safe. In 
such circumstances, pieces of folded linen dipped in cold water 
should be applied and frequently repeated, or kept constantly 
wet with cold water till the local inflammation is subdued. 



3d, If in consequence of the too long continued application 
of the cold water, symptoms of constitutional disturbance, 
such as cramp of the stomach or comatose symptoms should 
come on, stimulating applications, such as sinapisms with ex- 
ternal warmth, should be immediately; applied to the limbs, and 
opium and camphor, or camphoratea tincture of opium, and 
volatile tincture of guaiacum in sufficiently large and repeated 
doses should be administered in any appropriate warm liquor. 
After which, if the topical inflammation becomes again esta- 
blished, the cold topical applications may again be employed, 
only of somewhat higher temperature than at first. By this 
treatment judiciously conducted, a happy and speedy termina- 
tion may be generally expected in cases of acute and regular 
gout. But in the chronic state, or atonic form of the disease^ 
in which the different functions are disturbed or imperfectly 
performed, and especially in exhausted constitutions, such 
treatment is not only hazardous but totally inadmissible." 



l HI 

ERYSIPELAS 

OR 

ST. ANTHONrS IIRL 



Tins disease is placed by Dr. Cullen in class first, order 
third and genus twenty-sixth, and is a species of the erythema, 
which differs from the phlegmon in the following circum- 
stances, \i/.. in the latter, the inflammation particularly affects 
the vessels on the internal surface of the skin, communicating 
with die lax adjacent cellular texture, whence a more copious 
effusion of serum convertible into pus, takes place. In the 
former, the affection is of the vessels on the external surface, 
communicating with the rete mucosum, which does not admit 
of any effusion but what separates the cuticle, and occasions 
the formation of a vesicle, while the smaller size of the vessels 
admits only of the effusion of a thin fluid, very seldom con- 
vertible into pus; for " although arteries, veins, nerves and ab- 
sorbents have their termination in the skin, they do not com- 
pose its substance. Its basis is a membranous substance con- 
sisting of condensed cellular matter." 

The erysipelas of the face, where this affection most fre- 
quently appears, comes on with a cold shivering and other 
symptoms of pyrexia. The hot stage is frequently attended 
with a confusion of the head, and some degree of delirium, 
almost always with drowsiness, and sometimes with 



146 

coma or insensibility. The pulse is always frequent*, and 
commonly full and hard. AVTien these symptoms have con- 
tinued for one, two, or at most three days, an erythema (or 
redness and swelling) appears on some parts of the face. This 
is at first of no great extent ; but it gradually spreads to the 
Other parts of the face ; and from the face it often spreads 
over the hairy scalp, and descends to the neck. As the red- 
ness spreads, it commonly leaves, or at least, becomes less in 
the parts it had before occupied. All the parts are also af- 
fected with some swelling which continues for some time af- 
ter the redness has abated. The whole face becomes consi- 
derably turgid ; and the eyelids are often so much swelled as 
entirely to conceal the eyes. • When the redness and swelling 
have continued for some time, blisters arise of a larger or 
smaller size on several parts of the face ,* these contain a 
thin colourless liquor, which sooner or later runs out. The 
skin in the blistered places sometimes becomes livid and 
blackish ; but this seldoYn goes deep, or discovers any gan- 
grene affecting the skin. On the parts of the face not affected 
with blisters, the cuticle suffers, towards the end of the disease, 
a considerable desquamation. Sometimes the tumour of the 
eyelids ends in suppuration. The inflammation on the face 
produces no remission of the fever; and sometimes the fever in- 
creases with the spreading inflammations. The inflammation 
often continues for eight or ten days, as w^ell as the fever and 
other symptoms attending it. In the progress of the disease, 
the delirium and coma attending it sometimes go on increasing, 
and the patient dies apoplectic on the seventh, ninth, or 
eleventh day. In such cases it has been supposed, that the 
diseased action is translated from the external to the internal 
parts, 



147 



fREATMENT. 



\ annot suppurate, this disease must be i 

s< d, 01 it -\>. 1 1 1 end in a mortification : hence remedies which 
cool and abate the motion of the vessels and of the inflamed 
surface are requisite." KirAland, Vol. l.p, 3 

This disease is to be treated by the usual means of obvia- 
ting inflammation by bleeding, if indicated by the state of 
pulse, In and by antimonials. After these evacua- 

tions, blisters may be applied to the seat of the affection, pro- 
v ided no symptoms of typhus fever, nor of gangrene in the 
inflamed parts are observable, the body being kept as much as 
possible in an erect posture, and the quantity- and quality of the 
aliment should be adapted to the state of vigour or force of 
arterial action. 

AVith a topical view, the best applications, according to 
Hoffman and Dr. Culle-n, arc dry meal}- powders, as gum ara- 
ble, starch and rye meal, oat meal or starch. But Dr. Kirk- 
land, in his medical surgery, gives the preference to coo 
emollient applications, which he says he had been in the prac 
tice of using for more than thirty years. "When occurring in the 
other parts of the body, erysipelas is generally preceded by 
drowsiness and other feverish symptoms, which depart on the 
appearance of the inflammation and are seldom dangerous, 
but the disease sometimes shifts its place, and leaving one 
part, attacks another. 

AVhen the heat and pain of the affected part are consi- 
-i)lc, Dr. Beddoes says he has "experienced immediate 
ease and rapid recovery from the application of cold water, 
first by affusion, and as soon as the heat and pain had subs! 



148 

ded by the application of linen cloths, kept constantly wet 
with cold water. During this process, the application of the 
cold water must not be remitted for some time after the pain 
and heat have subsided, otherwise reaction will come on and 
render the complaint worse." 

To prevent any danger from this remedy, some mild warm 
aromatic infusion may be taken occasionally : such as an infu- 
sion of ginger, or calamus aromaticus, &c. 

Some cases of erysipelas exhibit a gangrenous aspect; 
and, when this occurs, the bark, wine, and other tonic and sti- 
mulating remedies should be employed internally, and the 
gangrene of the part prevented by spirituous fomentations 
and cataplasms, &c. The fomentations may be composed of 
a decoction in water of Peruvian bark and chamomile flowers, 
to which may be added, one-fourth or fifth of brandy, or spi- 
rits of wine with a few grains of camphor dissolved in it ; 
and the cataplasms may be composed of porter, thickened 
with the powder of cortex, chamomile flowers and oatmeal, 
or crumb of wheat bread, provided the affected part has be- 
come insensible, or nearly so ; otherwise, every strongly sti- 
mulating application, will increase the suffering of the patient 
without obviating the progress of the disease. 

If the swelling should suddenly subside, and be followed 
by oppression and anxiety, with a weak pulse, it will be pro- 
per to have immediate recourse to blisters, sinapisms, and hot 
spiced wine, which should be given freely till the pulse rises, 
and afterwards at stated intervals, to prevent the return of 
this dangerous and menacing condition. Six or eight grains 
of volatile sal ammoniac, and half the quantity of powdered 
camphor, made into pills with conserve of roses, or any thing 
suitable for that purpose, may also be given with the same in- 



tenftlon, every two 01 three hours, or 1 j oi 

symptoms ma) require. If pill . an taken with difficulty, 
the same medicines ma) be made into a julep with simple 
peppermint or cinnamon water, with the addition of the pow- 
der of gain arabic and white sugar, the camphor being first 
softened with spirits of wine or brandy. 

Sometimes oftheei breaks out about the 

middle of die !>od\ , surrounding it like a belt, (though it morr 
frequently occupies only one side, most commonly the right 

under the short ribs), it is tin n called the zona aurea, or 
shingles, from cingulum, a belt or girdle. In this case there 
e small vesicles, of a yellowish colour and frequently 
blackish. The fever, which attends this form of the disease, 
is generally slight, and preceded by pain in the side and some 
tsnaach. 

Some practitioners have been so apprehensive of convert- 
ing the erysipelas into a fever with typhus symptoms, or of 
its terminating in gangrene, (which has frequently occurred 
in intemperate livers, and persons of impaired constitutions) 
that they have too often neglected the necessary evacuations, 
indicated by the inflammatory symptoms, with which the di- 
sease is generally attended at the beginning ; in consequence 
of which, indirect debility has been induced to the great dan- 
ger of the patient. 

It requires no small share of sagacity to determine the state 
and condition of the general system, previous to the application 
of blisters to cutaneous inflammations, otherwise, if a gangrene 
had begun, and the system was in a state of great debility, 
or a tendency to typhus existed, they would necessarily in- 
crease that tendency by stimulating the vessels of the skin too 






150 

violently far them to bear in their weak condition, without 
exhausting their remaining vitality. 

Dr. Willan, in his description and treatment of cutaneous 
diseases remarks, that all the ancient writers, except Galem 
recommended blood-letting in the treatment of erysipelas. 
This practice, Dr. Willan thinks, must evidently be improper 
in all cases, excepting those in which the disease is connected 
with, or partakes of the phlegmonous inflammation, and even 
in such cases repeated blood-letting aggravates the symptoms 
and protracts the disease in the climate of England. 

" In a comatose or apoplectic state, leeches or cupping- 
glasses to the nape of the neck may be advisable ; and he 
asserts that he has applied blisters occasionally between the 
shoulders with manifest advantage, when the face and scalp 
were affected. Dr. Willan adds, I must however observe, 
that it is not safe to put either blisters or leeches on or near 
to the diseased surface. 

" In the erysipelas cedematodes we should employ blisters, 
diaphoretics, volatile alkali, and purgatives, during the first 
two or three days, and afterwards Peruvian bark, conjoined 
with diuretics. By these means the duration of the complaint 
may be considerably shortened." 

When the erysipelatous inflammation has a gangrenous 
aspect, and the fever is accompanied with typhus symptoms, 
a free use of the bark is necessary with wine and opium in 
moderate doses, and the external application of camphorated 
spirits of wine ; and in cases where sphacelus has actually 
commenced, poultices frequently applied, made of wheat 
flour, yeast and charcoal, in the act of fermentation or rising : 



151 

m other respects, the plan and regimen should be the same 

. 

\\ hen an offensive odour exhales from the- sphacelated sur- 
, powda tl added to the poultices, is particularly 

correcting it. 



OF THE EPISTAXIS; 

OR 

// E310RRHAGE FROM THE NOSE. 



The bleeding of the nose, as it appears in this country, 
agrees so perfectly with its appearance in Great Britain, as 
described by Dr. Cullen, and not knowing of any improve- 
ments that have been made in the treatment of it since his 
publication, I shall refer the reader to the chapter of his prac- 
tice of physic, where he has treated of this disease. 






OF THE HEMOPTYSIS, 



OR 



HEMORRHAGE FROM THE LUNGS. 



This disease belongs to tEe fourth order of the first class. 

"When after a painful sensation in the thorax and titillation 
about the glottis, accompanied with febrile symptoms, blood 
is brought up by coughing, of a thin consistence and of a 
florid colour, we may conclude that it comes from the lungs. 

The blood vessels of the lungs are more numerous than 
those of any other part of the body of the same bulk. These 
vessels of the largest size as they arise from the heart are 
more immediately than in any other part, subdivided into 
vessels of the smallest size, and these small vessels spread 
out near to the internal surfaces of the bronchial cavities, are 
situated in a loose cellular texture and covered only by a 
tender membrane ; so that considering how readily and fre- 
quently these vessels are overcharged with blood, we may 
understand why an haemorrhage from the lungs is next to that 
of the nose, the most frequent of any. When the blood be- 
gins to flow it irritates the top of the larynx ; to relieve this 
the patient coughs or rather hawkes, which brings up a little 
blood of a florid colour and somewhat frothy appearance, 






During this action th mmonly some noise in the 

Lssing through a iluid. Thi 
up copiously in the act of coughing* 



TREATMENT. 

An hemoptysis may generally be moderated by avoiding 
fer removing irritation that might concur to increase or pro- 
it ; hence in every case where the motion arid force of 
the circulation i* increased, every part of the antiphlogistic, 
vegimen is to be observed ; cool air is to be admitted, and 
cool drinks of a sedative quality, by which I mean those 
which abate arterial action, are to be administered* In addi- 
tion, therefore, to bleeding, purging and a refrigerating regi- 
men, the patient should take from 9i. to 3j. of sal nitri dis- 
solved in an infusion of tamarinds and manna, or of senna 
and cream of tartar every hour till the haemorrhage ceases • 
When the haemorrhage, from hawking or coughing up oi 
blood continues without much diminution after free blood- 
letting, double linen cloths wrung out of cold vinegar 
and water, applied to the thorax and frequently renewed, sel- 
dom fail of suspending the disease ; the recurrence of which, 
may generally be prevented by subsequent purging, and the 
application of an epispastic to the thorax, especially when 
aided by the internal use ofsaccharum or extract, saturni, ad- 
ministered from one to four grains and repeated every hour 
till the haemorrhage ceases, and afterwards at longer intervals* 
In certain cases of hemoptysis and other haemorrhages the 
resistance of the small arteries is not in due proportion to the 
usual vis a tergo, or propulsive power of the heart. Hence 
this form or state of the disease is called passive, but in other 
cases th g excessive forces the ends of the 

20 



154 

small arteries open, though they may be in a healthy state. 
In the latter case, remedies to reduce the excitement and 
force of the circulation are requisite, in the former, those th?t 
give tone to the extreme vessels without increasing the force 
or frequency of the action of the heart and arteries. 

Opium has been observed to increase the haemorrhage if 
given while the pulse is strong, quick and active. But after 
copious and repeated venesection it frequently prevents a re- 
currence by obviating excess of sensibility and increasing ex- 
citement. 

Of the good effects of blisters in preventing a recurrence 
of the discharge of blood when applied to the thorax after the 
disease has been of some days continuance, I have frequently 
been a witness* 

Issues which have been supposed by several writers of 
experience to be more certain in that respect than blisters, I 
have never found of the least service. 

Flannel worn next to the skin in debilitated habits is always 
useful, and has been frequently known to prevent a return of 
this complaint. 

As a preventative of the recurrence of this disease mode- 
rate exercise, especially that of sailing, because it is not at- 
tended with much muscular exertion, is peculiarly service- 
able. 

At the commencement of this complaint too great caution 
cannot be observed with respect to indulgence in any thing 
that has a tendency to quicken the pulse, or heat the body : 



for m th i i-, always inflammatory and \a accom- 

panied with fei 

Dr. Percival observes, that " in the treatment of the he- 
moptysis the antiphlogistic plan is now generall) adopted in 

it parts of England, and during the incipient stage of the 
disorder, when the inflammatory diathesis commonly prevails, 
much injury may be done hy heating styptics and rough 
astringents j hut when the disease has heen of some continu- 
um < iivquentU recurred, its type is often changed. 
And main cases occur which even in their commencement, 
indicate great laxity of the solids and tenuity of the fluids, 

a debility of the extreme arteries in the lungs and bron- 
chia. Under such circumstances venesection, nitre and the 
debilitating class of medicines are highly improper, though 

it authorities have sanctioned their use, without sufficient 
discrimination. When the discharge of blood has continued 
for a considerable time, a new state of the system is induced. 
* w The heart and arteries seem to lose their due degree of tone ; 
an increase of irritability takes place in the ruptured vessel, and 
in those which are contiguous to it ; and thus the impetus oi 
the circulation is partially augmented with a diminution of 
its general energy." — The correctness of this remark is ex- 
emplified in cases of opthalmia." 

There are two distinct stages in the progress of opthal- 
mia. The first is characterised by a sense of heat, acute pain, 
intolerance of light, and a florid colour of the vessels of the 
conjunctiva, indicating an increase in the action of the ves- 
sels, and an increased quantity of blood in those vessels ; the 
second distinguished by a sense of weight, obscure pain and 
turgescence of the vessels, which in this stage are of a dark 
purple hue, indicating an action less than natural, anc^s tJie 



consequence of the preceding increased action. But^P^ecn 



~.djs I 
betv 



* 



156 

these extreme points, there are numerous gradations in the 
series of arterial action. It is however only by keeping these 
constantly in view, that the means of cure can be applied cor- 
rectly and successfully, or that remedies of the most opposite 
nature can be used in succession with advantage." 

Remedies, therefore, which rouse and strengthen the vital 
powers and excite a vigorous and equable action in the vas- 
cular system, are clearly indicated in such cases of hemop« 
tysis, as shew evident loss of arterial strength. 

A blister applied to the back has cwm/a nasal haemorrhage* 
Wine drank in moderation at stated intervals of three, four, 
six or eight hours, has cured both hsematuriae and hemopty- 
sis when other means have failed. Laudanum in small doses 
has " also had the same effect in numerous instances. Dr. 
£ercival says, a lady of a very delicate and irritable habit 
was cured of an hemoptysis by taking a grain of opium every 
twelve hours. She gradually increased the dose to twenty 
grains per day, and after the disease left her she continued 
it in the quantity of ten grains every twenty-four hours for 
nearly nine years." 

Several persons in America have frequently found relief in 
cases of hemoptysis, from swallowing slowly a tea spoonfull 
or more of dry Lisbon salt in fine powder, whose systems 
were in an infirm and debilitated state ; and have frequently 
prevented a recurrence of the complaint by taking Peruvian 
bark freely with the moderate use of claret and making use 
of a more substantial diet than usual, wearing at the same 
time in the cold season a flannel shirt and drawers, and wor- 
sted stockings, and taking moderate exercise iu the open 
air. 



Dr. Claypoole, of Norfolk, in Virginia, informed 
that he frequently suppressed the hemoptysis in himself 

taking six drops of tin oleum surcin. mixed with the yolk 
id white sugar. He was very much relaxed and 
debilitated at the time by the summer heats and unwholesome 
air of Norfolk. 

The late Dr. Peter lilentworth, of Philadelphia, after ha- 
ving been subject to frequent recurrences of hemoptysis, 
(which had become more frequent and alarming while he 
lived entirely on a milk and vegetable diet), prevented the 
return of the disease in himself by taking half a pint of strong 
hot wine sangree, every night for a few weeks, drinking three 
glasses of pure wine in the course of the day, and living on 
a more substantial and invigorating diet. 

Before he made trial of the hot wine sangree at night he 
had frequently been prevailed on to take part of a glass of 
wine before dinner when he felt weaker than usual, which 
generally occasioned a cough and a return of the hemoptysis. 
But he had no return of the complaint after he had taken the 
warm sangree a few nights and had changed his mode of 
living. 

The following prescription is recommended for hemoptysis 
and other haemorrhages in the third volume, London Medical 
Transactions, and bids fair to afford relief in debilitated and 
very irritable habits. 

§>. Extract, saturni §i. et 3vi. 
Tinct. thebaic. 3ij. m. 

Twenty drops are directed to be taken every four hours, or 
of tener in a small draught of cool barley water, with the addi- 
tion of a little gum arabic. 



log 

Sea-salt has of late become a very fashionable medicine in 
cases of hemoptysis. But its indiscriminate use must certain- 
ly be improper. As this salt not only assists digestion but in- 
vigorates all the bodily functions by stimulating and contract- 
ing the fibres, it is evident that its exhibition can only be proper 
in cases of general debility or atony of the extreme arteries, 
or when the general vigour of the arterial system is impaired. 

A very interesting" example of the beneficial effects of the powder of 
digitalis in this disease, may be seen in Duncan's Medical Commentaries for 
1786, page 315. 

The tincture of digitalis from its usual effects on the pulse after a few- 
days use, has induced many physicians to make trial of it in this disease, 
but they differ so much in their account of its effects, that I am at a loss to 
determine whether It is a remedy that can be depended on in this disease or 
not. If it stimulates the arterial system to the degree asserted by Dr. 
James Sanders of Edinburgh, soon after it is received into the stomach in- 
stead of being beneficial it must necessarily aggravate the disease till its 
stimulating operation has induced indirect debility in the vital functions. 
But from its beneficial effects in the incipient stage of phthisis pulmonalis, I 
very much question the correctness of Dr. Sanders's opinion, and should 
not hesitate to employ it in any case of haemoptysis accompanied with 
preternatural frequency of pulse in conjunction with frequent venesection. 
and copious purging. 






<V| THE PHTHISIS PLLMONAJLIS, 

OR 

CONSUMPTION OF THE LL/A< 



Tins disease is defined by Dr. Cullen and Dr. Thomas 
Held, to be an expectoration of purulent matter from t\v. 
lungs attended with hectic fever. 

There are however many instances of the disease termina- 
ting fatally, without any purulent matter appearing in the 
ctoration at all. I have seen three cases of this kind my- 
self, in each of which the whole internal substance of die 
lungs was filled with a whitish s1)lid substance resembling 
new chec 

The phthisis pulmonalis may therefore more properly be 
defined an affection of the lungs, attended for the most part 
in its progress or advanced stage with ulceration and expecto- 
ration of purulent matter, and always with more or less fever 
of a remitting type, commonly termed hectic* 

* Dr. William Hebcrden, in His Commentaries p. 186, says that in the 
clearest remissions of hectic fever from internal suppuration or ulceration, 
there is tlwaj s some preternatural quickness of pulse, so as to exceed the 
number of pulsations in a state of health at least ten stroke:; in a minute. The 
fits of the hectic also vary from one another, seldom continuing- to return iu 
' i unc manner for more than three times together. The chill or shire i i 



I 



160 

The following symptoms denote the approach of this disea^ , 
viz. a slight and short cough, which becoming habitual, is 
seldom noticed by those affected till succeeded by additional 
symptoms. This cough is generally aggravated by the 
slightest alteration in the temperature of the atmosphere, es- 
pecially to a colder state, the consequence of which are catarrhal 
symptoms, accompanied with slight stitches in the thorax, 
particularly under the sternum* Hence the patient in the in- 
cipient or approaching stage of this disease, is more affected 
during the winter and spring seasons than at any other time ; 
the symptoms generally decreasing as the summer increases. In 
process of time the breathing becomes easily hurried by any bo- 
dily motion^ the patient loses flesh, complains of being frequent- 
ly indisposed, and is generally languid and feeble till after din- 
ner, which he generally eats with a good appetite, but has 
seldom any relish for his breakfast. 

"When the cough is accompanied with dyspnoea, and is dry 
or sonorous, or only accompanied with tough, white, frothy 
phlegm, it is a strong indication that tubercles are formed, 
and when to these symptoms a fever is joined, the disease may 

sometimes immediately succeeded by perspiration without any intervening 
heat ; sometimes it begins with a sense of heat without any preceding cold ; 
and the patients sometimes experience the usual dullness without any fol- 
lowing heat or sweating. The fits therefore of the hectic are usually 
shorter than that of an intermittent or remittent, not only in the three stages 
of chill, heat and perspiration, but one of them is often wanting and some- 
times even two of those stages. 

Dr. Heberden says, he had observed all the symptoms of pulmonary con- 
sumption except expectoration of blood or pus in a person whose lungs 
after death were found sound, owing to a diseased state of his mesenteric 
glands ; he however adds, " this happens so very seldom that very little 
doubt is to be made of the diseased state of the lungs, where all the other 
symptoms concur, though these two should be wanting. 

Commentaries on the History and Cure of Diseases, p. S72 



nil 

uskfered as begun, and may with propriety be called the 
first stage, during which the pulse is always more or I 
hard, and more frequent than in health, indicating an in- 
flammatory affection* 

If proper means arc not employed for the relief of those 
symptoms, the fever gradually becomes more intense, the 
rough more troublesome and frequent, especially upon the pa- 
dent's lying down at night J and is longer before it abates 
than is usual in cases of common catarrh. The fever and 
cough become perceptibly increased after eating, especially of 
solid meats, accompanied with a sense of burning heat in the 
palms of the hands and soles of die feet, with flushing of the 
lace, most commonly of one cheek. 

After some time the violence of the fever and cough remits 
considerably, and in many cases intermits about two or four 
o'clock in the morning ; the expectoration of phlegm at that 
time becoming more copious and the fever going off with 
more or less perspiration about the breast and upper parts of 
the body. 

The fever and cough, however, generally return again about 
noon, and go off about four or five o'clock P. M. returning 
again between six and eight o'clock in the evening, and ha- 
rass the patient till two or three o'clock in the morning, 
after which the feverish symptoms subside and he gets some 
sleep, but for the most part rises unrefreshed, feels a gene- 
ral languor and appears pale and bloated in the face. 

The expectoration now becomes more copious, more viscid, 
more opaque, and at length of a deep yellow or greenish 
colour and of a purulent appearance, but still blended with a 
considerable portion of mucus. 

at 



! 



162 

When the fever has regular remissions, when the sweats 
come on every morning, and when the patient expectorates 
mucus copiously mixed with pus, in small globular masses of 
a deep yellow, greenish or ash colour, the disease may be con- 
sidered as in its second stage, and may be denominated a 
confirmed pulmonary consumption. 

In this stage, the fever, after remitting in the morning, 
comes on about the middle of the day, continues two or 
three hours, then intermits and returns again about five or 
six o'clock in the afternoon. 

The patient now becomes daily more and more emaciated, 
his eyes become hollow and dull, his cheeks become prominent, 
and his nose sharp, his throat sore, his cough hoarse and hollow, 
and expectoration difficult ; his countenance appears expressive 
of anxiety and dejection, particularly in the fore part of the 
day, but in the afternoon he generally appears more lively, 
and he feels less debility and of course flatters himself that he 
is better and may yet recover. But at length a coliquative 
diarrhoea succeeds, his expectoration together with the sensi- 
ble heat of his skin diminishes, while his thirst increases, his 
legs swell, his strength rapidly declines, and death puts a pe- 
riod to his hopes and suffering together. 

The succession of symptoms which I have now described, 
occupies more or less time in different cases. 

In the climate of Pennsylvania they very often take up se- 
veral years, the symptoms appearing to be aggravated every 
winter and spring, commonly abating and sometimes almost 
disappearing during the summer, but returning again in the 
winter ; they at length prove fatal towards the end of spring 
or beginning of summer, and not unfrequently in the month 



A .lulv or August when the weather happenaa to b< mt< n u \y 
hot 

PROGNOSIS. 

In this disousc, the prognosis is for the most part unfa- 
vourable ; oi those affected by far the greater number die. 
Some, however, though the number has been very small, 
have recovered completely, after having been in very unpro- 
mising circumstances. In the few that I have seen recover 
the disease was preceded by hemoptysis ; I have also seen 
manv persons with chronic catarrh recover, where it was mis- 
taken by the inexperienced for true phthisis pulmonalis, but 
never a single case where the disease was preceded by the 
symptoms, which denote the existence of tubercles in a state 
of ulceration. 

" The danger of phthisis, from whatever cause it may 
arise, is most certainly to be judged of by the degree to which 
the hectic and its consequences have arisen." 

" From a certain degree of emaciation, debility, profuse 
sweating, and diarrhoea, no person recovers." 

The pregnancy of women, has often retarded the progress 
of the disease, but commonly it is only till after parturition, 
when the symptoms of phthisis return with greater violence, 
and in general soon prove fatal. 

REMOTE CAUSES. 

The cold, wet, and changeable weather, which occurs in 
many parts of United America in the winter and spring sea- 
sons, render the inhabitants more liable to catarrhal, pneumo- 






164 

nic, and rheumatic affections, than those of milder and more 
regular climates. 

The same causes subject those, whose constitutions favour 
their operation, to glandular obstructions, scrophulous com- 
plaints,, and tubercles in the substance of the lungs. An ab- 
stemious regimen, and too much confinement to the house, 
in a hot, confined, and relaxing air, by debilitating the whole 
system, and exposure afterwards to the cold damp air, fre- 
quently lays the foundation of this complaint. 

On examining the lungs of persons, who have died of pul- 
monary consumption, besides open ulcers, little hard tumours 
called tubercles, are generally found, some with pus, others 
upon being cut open, discover a little bluish spot, of the size 
of a small lead shot. In some, the tubercles are perfectly 
solid and of a whitish colour throughout the whole substance ; 
and, I have seen more than one instance of their resembling 
new cream cheese, both in colour and consistence. In the 
case of a negro child, about two years of age, which was sup- 
posed to have died of what has been erroneously called a 
worm fever ; which was opened at my request by the late 
Dr. Waters, the author of the Abridgment of Benjamin 
Bell's Surgery, this was particularly observable. 

A great number of exhaling vessels open into every part of 
the body, these secrete a fluid, which preserves their cavities 
moist, and by lubricating the surface of the different viscera, 
enables them to move on each other, without difficulty or 
inconvenience. 

In the lungs these vessels secrete a large quantity of 
lymph, which is carried off by the air in respiration. 



IV •, or apertures of these vessels, from any cause 

li excites inflammation, (particulary from the frequent re- 

currence of catarrh) may be altered so as to secrete a viscid 

matter, like thesi/.v gelatinous substance or coagulable lymph 

of blood, which has the property of coagulating immediately 

r secretion. 

The exhaling vessels in the lungs, having their orifices so 
altered by catarrh, or other cause, as to produce this viscid 
condition of the lymph, a less quantity will be secreted; and, 
if from the effects of cold and moisture, the ends of the exha- 
ling arteries on the surface of the body are contracted, and a 
larger quantity of fluids than usual repelled and determined 
to the lungs, they will be loaded and oppressed ; their paren- 
chimatous substance will become more dense and inelastic ; 
the diameters of the various branches of the pulmonary artery 
and vein, will be lessened by the pressure, and consequently 
the circulation of the blood through this organ impeded. 
"When the lungs are in this state the patient will breathe quick, 
and with difficulty, he will feel pain in different parts of the 
thorax, and a general soreness and sense of fullness upon a 
deep inspiration. 

If disease produces such an alteration in the exhaling ves- 
, as to occasion such viscidity in the lymph which they se- 
crete, the same cause continuing to act, will occasion a den- 
sity in the substance and texture of the vessels themselves 
till their extremities coalesce and become obliterated, or the 
lymph obstructed in them becomes solid and firm. These 
tubercles were formerly supposed to be diseased lymphatic, 
glands ; but the dissections of the ingenious and discerning 
Mr. Stark (who in the prime of life fell a victim to his zeal 
for experimental inquiries), clearly prove that they are the 
effect of diseased exhaling vessels, and not glands. Glands, 
however, have been discovered by Mr. Cruickshank in the 



166 

lungs, as well as in the bronchia ; of which he has given an 
account, in his anatomy of the absorbent vessels, at pages 
J 29 and 177, published in 1786. 

TREATMENT. 

From the view which has now been given, of the nature 
and causes of pulmonary consumption^ the indications for pre- 
venting the disease from forming in those who have symp- 
toms, which indicate its approach, appear to be to avoid the 
exciting causes and to counteract the predisposition by such 
means as have been discovered by experience to have the ef- 
fect of withdrawing the determination from the lungs, and for- 
tifying the system generally. 

The means best adapted to this end are to wear flannel next 
to the skin at all seasons in this climate, excepting the two 
sultry months of July and August, during which short period 
line muslin or calico may be substituted. 

Worsted stockings have also been found, when worn 
under fine silk chief part of the year, particularly serviceable. 
These preserve an electric atmosphere around the patient, 
which in some measure prevents the dampness of the air from 
abstracting too much animal heat and checking the perspira- 
tion ; especially if the feet are preserved dry by means of 
water-proof shoes or boots* 

But when from a bad structure of the thorax, neglect of 
rules, or unavoidable exposure to the remote causes, symp- 
toms come on which indicate the existence of tubercles, and 
the cough becomes dry and obstinate or attended only with 
an expectoration of tough white mucus mixed with froth, or 
which is sometimes streaked with blood, attended with stitches 



167 

m different parts of the thorax, and tin u itfa h< are increase 
ed upon coughing, and accompanied with hectic heats, the di ; 

e tnaj be considered as in its hist or inflammatory sts 
and to strip it from terminating in ulcc rations of the tubercles, 
must be had immediately to blood-letting in quantity 
and frequency proportioned to the existing symptoms of local 
inflammation as indicated by the pain and fever; mild purga- 
tives and the antimonials usually employed in other inflam- 
matory affections are also to be employed, together with the 
rigid observance of the antiphlogistic regimen. A blister 
should also be applied to the thorax as soon as the plethoric 
state of the lungs has been diminished by bleeding and pur- 
ging, and should be renewed as often as it begins to heal. 

When by these means the immediate danger of suppura- 
tion and ulceration is prevented, an issue or a seton is of 
the highest service in preventing a recurrence of those threat- 
ening symptoms. 

Drinks, the most cooling and demulcent are to be employ- 
ed, and when the cough continues, only from irritability', 
gentle anodynes and mucilaginous liquids are requisite. For 
this purpose, tea, made of linseed or marsh-mallows, quince 
seed, the leaves of the tussilago or coltsfoot, &c. or a decoc- 
tion of barley, liquorice root and gum arabic, emulsions of 
almonds, and gum arabic, &c. 

Dr. Mudge, of Plymouth, relates that he Mas cured of an 
incipient phthisis pulmonalis, attended with dry, husky, tea- 
zing cough and hectic heats, by occasional bleedings, cooling 
and laxative medicines, a steady course of temperance, cloth- 
ing adapted to the conditions of the seasons and weather, and 
keeping open an issue for twelve months made by caustic be- 
tween his shoulders, so large that it held between forty and 
fifty peas of the common size. 






168 

The chief of the means most proper for preventing the for- 
mation of tubercles, and for the cure of this disease in its in- 
cipient stage before suppuration or ulceration have taken 
place, have now been enumerated ; but when they are not 
employed in due time or submitted to with sufficient punctu- 
ality, exactness and perseverance, the tumours already descri- 
bed suppurate and become open ulcers, accompanied with a fe- 
ver and an expectoration of purulent matter. 

In this stage of the disease, new indications different from 
the former arise. 

The healing of an ulcer is supposed by eminent teachers to 
depend on procuring an absorption on its surface greater than 
the secretion or deposition of purulent matter, and those me- 
dicines which induce nausea and sickness having been observ- 
ed to produce this effect, and the digitalis in particular in 
an eminent degree ; numerous trials have been made with the 
last mentioned remedy in different parts of the world, the re- 
sult of which as far as I am qualified to judge appears to the 
credit of this medicine when employed in and restricted to 
the first and to the early part of the second or ulcerated stage, 
or so long as the frequency and hardness of the pulse indicates 
the existence of inflammation in the ulcerated tubercles. 

The following are the forms and manner in which it is 
most commonly exhibited. 

§>. Fol. digital, purpur. recent, exsiccat. unciam unam. — 

Spir. vin. rect. §viii. m. digere in leni calore per 

dies septem, deinde cola. Or 

Infuse four ounces of the fresh leaves in five ounces of 

rectified spirit of wine, digest for seven days in a gentle 

heat and strain off the liquor. 



From ten to fifteen cL tincture*, 

times a i .; two drops ei 

second day until the habit begins to feel its influence, and the 
pulsations of the arteries are reduced below the healthy num- 
ber. The number of drops is then to be diminished in the 
ame gradual manner until the medicine ceases to have any 
sensible effect on the pulse, the number is then to be again 
increased as at first, until its effects are visible. 

f»v these means the circulation may with the greatest stifcU 
be kept under the influence of the remedy for weeks, and even 
for months.* 



* Dr. Baildon of London when surgeon of the East India Company's ship 
Alfred in 1803, took for a cough accompanied with hectic fever which su- 
pervened the rupture of a blood vessel in his lungs, half a grain of digitalis 
in the form of pills gradually increasing the quantity daily till he took eleven 
grains a day : by this his pulse which when he began with the digitalis was 
about one hundred and ten, was reduced to forty, and by taking five grains 
a day, was kept at that rate for nearly three weeks. His pulse then sinking 
<o thirty-six and intermitting, the pills were discontinued; but it was near- 
ly a month before his pulse recovered its natural standard, about seventy- 
two. No sickness at stomach was ever induced, and only once or twice 
objects appeared double to him. The only troublesome effect was great 
costiveness and sense of heaviness in his head, that always inclined him to 
lie down. 

Dr. Baildon observed that after the digitalis had taken effect, his pulse 
immediately increased in frequency upon rising out of bed and standing up, 
and that upon sitting down the number of pulsations decreased considerably, 
and that upon lying upon his back it decreased much more. Thus during 
the time it was forty while lying, it was about seventy-five when sitting, and 
above one hundred when standing; and when he turned on either side it 
fell two or three and intermitted. In exhibiting digitalis, he thinks it 
should never be increased more than half a grain a day unless the symp- 
■ rgcnl Med. & Shrg Jo:: 



170 

To those who prefer this medicine in substance a single grain 
of the powder, prepared from the leaves carefully dried 
m the shade (excluding the fibrous parts) is a medium dose for 
an adult to begin with, increasing half a grain every second 
day until some effect on the stomach, head and pulse be 
evident. 

As the digitalis sometimes operated as an eVacuant with ex- 
treme violence even in small doses, Dr. "Darwin advises a sa- 
turated tincture of it as more manageable than in any other 
way : for this purpose he directs two ounces of the powder of 
the leaves to be infused in a mixture of four ounces of rectified 
spirit of wine and the same quantity of water. Of this from 
thirty to sixty drops from a two ounce vial are to be taken 
twice in the morning part of the day, and to be so managed 
as not to induce violent sickness. If sickness nevertheless 
comes on, the patient must for a day or two omit the medicine 
and then begin it again in reduced doses. 

Ipecacuanha, in doses of from one to three grains, most 
commonly two grains made into pills with castile soap, or 
into boluses with conserve of roses, has also been employed 
with most decided advantage in cases of confirmed consump- 
tion before the patients strength was greatly exhausted by the 
fever and night sweats. This medicine given at such inter- 
vals as to induce nausea of some continuance, as well as the 
digitalis, always reduces the frequency of the pulse, and mo- 
derates the fever under the recited circumstances. 

Blisters and opiates at night are generally proper auxiliaries, 
but the latter should be restricted to cases in which there is no 
great pain in the thorax, or hardness and tension of the 
pulse, 



IT) 

-, when it induces < 

diminish tin- frequency of tin- pulse and to 
promote pulmonary absorption, haseffe* 

aplete cove ; bence the utility i pflflh 

•which ap; rinciple, h inHodiir 

into practice by Dr« Carmich&d Smyth* 

The- powerful i noting absorption by inducing 

d observed in cases of dyspnoea con- 
nected with anas.; h empties the collected fluid, and 
the difficulty of breathing in a few hours. 

The common means of promoting absorption of matter in 
ulcers and ot* thickening the matter contained in them by taking 
die bar); -and opium internally, or by metallic salts, as of mer- 
cury, steel, zinc, and copper in small quantities, have been 
repeatedly used for the same purpose in phthisis pulmonalis ; 
and when the periodical accessions of the fever have been re- 
gular and the expectoration free and without pain, they have 
sometimes appeared to afford considerable benefit. Mercury 
in particular, as it cures venereal ulcers, and as pulmonary ul- 
cers resemble them in not having a tendency to heal, and in 
their tendency to extend themselves, might be expected from 
analog}' to succeed in the cure of consumption. 

Dr. Sims indeed tells us that he has cured persons affected 
with phthisis pulmonalis, connected with a venereal affection, 

the use of calomel in small doses, but adds, that he had 
never been so bold as to employ mercury after the lungs had 
suppurated, though he had been assured that a French phy- 

ian had employed it under such circumstances with 
q ucc Sbm ' on Epidemical Disorders, p. 119. 1768. 



173 

I myself frequently saw a mild preparation of mercury com 
posed of hydrargirus and chalk triturated together, employed 
by the late Dr. Thomas Bond at the Pennsylvania Hospital in 
the year 1772, but not one to whom he prescribed it recovered. 

Dr. Mossman of England, in a paper dated, at Bradford, 
November 24th, 1 800, published in the 5th volume of the 
London Medical and Physical Journal, observes that on the 
same principle that mania and pregnancy, suspend the progress 
of phthisis, mercury may be expected to produce a similar ef- 
fect when it induces salivation. 

As phthisis pulmonalis however generally returns with 
greater violence, and makes more rapid progress after the re- 
moval of mania, and especially after parturition in all the cases 
in which I have seen mercury employed, which have been a 
considerable number, the progress of the disease to its fatal 
termination has been more rapid after the affection of the 
mouth had subsided than where mercury had not been 
employed. 

The late experienced Dr. Cullen remarks in his First Lines 
of the Practice of Physic, section 919, that " mercury so often 
useful in healing ulcers has been speciously enough proposed 
in the treatment of phthisis pulmonalis ; but whether that it 
be not adapted to the particular nature of the ulcers of the 
lungs, occurring in phthisis, or that it proved hurtful, because 
it cannot have effect without exciting such an inflammatory 
state of the whole system as in a hectic state must prove 
very hurtful, I cannot determine ; but upon many trials 
which I have seen made, it has proved of no service, and 
commonly has appeared to be manifestly pernicious ," 



■.■late Dr« James Gurrie of Liverpool, in the 
relume of hia Medical Reports^ published in Ac year i 

laments that in confirmed phthisis pulmonalia, the hopes en« 

Certained of das digitalis have not been confirmed, though it is 

i in th prediaponem state, and even in the 

ient stage of the disease ; and in families where this 

fatal disease is hereditary, the use of digitalis as a prophylac- 
tic, he has no doubt will save man)' a life that would othenvi .. 
be but short. 

The same: author mentions that the practice of administer- 
ing mercury in confirmed phthisis had been revived by Dr. 
Rush and other physicians of Philadelphia, yet as it had failed 
in the hands of Dr. Dobson as well as in those of Dr. Duncan, 
and the late C. Webster, he should not have had recourse to 
it anew, if it had not occurred to him that it was reasonable 
to try it in combination with digitalis, though each might have 
failed separately. Accordingly (he says) about twelve months 
ago, u I put five cases of confirmed phthisis pulmonalis on a 
course of mercury within a short space of time, having 
bridled the circulation in each, by means of digitalis. I push- 
ed the mercury so far as to affect the mouth in all these cases. 
They all however terminated fatally, though I realty think 
the lives of all of them were prolonged. In one of them the 
• fleets appeared so considerable, that at one time I was led to 
entertain a slight degree of hope." 

Mr. R. Reece, author of the Medical Guide, says, mer- 
cury has been employed for the purpose of increasing the ac- 
tion of the absorbent vessels of the lungs in consumptive cases 
and adds that a case of pulmonary consumption, was sometime 
since published in a periodical work, as cured by small doses 
of mercury under the direction of Dr. Beddoes ; but that in 
•he trials he had made with it in the different stages of the 



ir4 

jiisease, it had by no means answered his expectations, having 
in every instance considerably provoked the cough, and in- 
creased the febrile symptoms. 

" Dr. Cullen maintained that when pus is expectorated in 
phthisis pulmonalis, it is always the consequence of ulceration 
of the lungs; but Dr. Simpson and Sir John Hunter have es- 
tablished, that pus is necessarily produced by all surfaces in a 
certain state of inflammation to which mucous membranes are 
particularly prone. Hence it is not always possible to distin- 
guish the matter expectorated in phthisis from that which is 
expectorated in cases of common catarrh." 

Sanders on Pulmonary Consumption, 

Common pus excluded from the air does not appear to have 
any corroding quality, and in that condition is frequently ab- 
sorbed and taken into the circulation without occasioning any 
fever or other sensible effect upon the system; but when exposed 
to the air it acquires a very different quality, as well as the sur- 
face from whence it is secreted, a very different aspect. 

"When ulcers are in that state of action, during which 
they heal, the matter discharged from them assumes the 
colour and consistence of laudable pus, the formation of 
which requires an action of the system very little stronger 
than that of usual health, to maintain which such a diet as the 
patient has been accustomed to when in health, or rather 
more stimulating and nourishing will be advisable, which is 
to be reduced or altered if inflammatory symptoms tend to 
violence ; but augmented and assiduously administered to- 
gether with medicines of a cordial and tonic kind, if the ac- 
tions of the system languish or indicate a state of debility c 



D the suppurative process begins to degenerate, and 
embling laudable pus, the expectorated matl 
thin viscid and transparent ; the remedies should be of the 
tive kind and persevered in, and their doses increased 
in proportion to the difficulty experienced in rousing the vital 
functions to the requisite activity ; and even though a consi- 
derable degree of lever should DC excited, they should be per- 
severed in until the expectorated matter assumes the proper 
form. 

V e are not to be deterred by the notions that the access 
of air to the wounded surfaces, or the continual motion of the 
lungs, frustrate all attempts to induce a cure, for ulcers often 
form in the lungs and heal spontaneously. In fine, what h 
chiefly to be dreaded is the spreading and degeneracy of the 
ulceration. When therefore the sputa become sanious, ill- 
coloured, fetid and putrid, the most invigorating diet and 
medicines should be employed at short intervals, observing to 
render all the aliment as grateful as possible ; and as super- 
oxygenated air has a powerful effect in promoting the activity 
and healthy granulation in the diseased surfaces, the patient 
ought under such circumstances to remove if possible to a 
healthy situation in the country, or to inhale as much as pos- 
sible of air rendered pure by art ; with this view the gas or 
vapour which is produced by pouring sulphuric acid, (spir. 
sulphur or oleum vitrioli) upon powdered nitre, (salt petre) 
contained in open china cups or bowls placed in different parts 
of the patient's chamber, is recommended by Dr. James San- 
ders of Edinburgh in his treatise on phthisis pulmonalis, pub- 
lished in the year 1808. 

A\ hen die disease has continued so long as to exhaust the 
strength of the patient to a great degree and he becomes em?.- 



176 

ciated and dissolved as it were with night sweats and pro 
fuse expectoration, neither digitalis nor any other remedy 
that promotes absorption by inducing sickness or vertigo has 
any effect in retarding the progress of the disease. The chief* 
that can be done is to palliate the symptoms till death puts a 
period to the sufferings and hopes of the patient. 

For this purpose the patient may drink freely and at plea- 
sure of beverage made of sulphuric acid and water sweetened 
with white sugar. Infusions of flowers of chamomile, columbo 
root, horehound &c. and to render his nights comfortable, he 
should take at bed time from one to three grains of solid opi- 
um, or from twenty-five to seventy-five drops of the spirituous 
tincture of opium. 

" If one ounce of the pure acid of lemons or two ounces of 
orange juice or the syrup of barberries be added to every grain 
cf the opium, or to every twenty-five drops of laudanum, instead 
of stupifying the person who takes it, and of being attended with 
painful costiveness, it will not only prove laxative but in- 
duce, first, a cheerfulness not attainable by the use either of 
opium or strong liquors alone, and will afterwards bring on a 
gentle and refreshing sleep." 

Though the patient should be confined to milk and vege- 
table diet and be prohibited from all kinds of fermented or 
spirituous liquors in the early part of the purulent stage of this 
disease, the object being now to palliate symptoms and to ren- 
der the remains of life more supportable, after the night sweats 
have become profuse and weakening and the morning inter- 
missions evident, he may be indulged with a small quantity 
of brisk small beer, porter and water, or claret and water, or 
artificial Seltzer water, wine whey, &c. and with flesh meats. 



177 

R-fiah, or boiled once or twice • day, when Fj 

from fever. 

In these circumstances whati isionB an agreeable 

latlon in the organs of digestion, and at the same t! 

gives them a gentle degree of tone, will frequently abate the. 

quickness of the pulse, and moderate the violence and fre- 
quency of coughing. 

The irritability however in many constitutions is so great 
through the whole course of the disease, as to render all 
kinds of strong liquors inadmissible, as well as every kind of 
animal food, especially in a solid form. In such cases rennet 
whey, mush and milk, and the mucilaginous farinacea will 
be preferable to any other kind of aliment. 

In the year 1 809, Mrs. A.... after having to all appear- 
ance nearly recovered from a confirmed phthisis, (with 
which she had suffered more than a year) ; by occasional 
blood-letting, the antiphlogistic regimen, and the free and 
long continued use of digitalis, increased her cough by taking 
cold during a long journey, and all her former symptoms re- 
turned. She being then absent from the city applied to *v 
phvsician in the country, who after having reduced the in- 
flammatory symptoms by bleeding, antimonial powders and 
a blister to the thorax, administered calomel in small and re- 
peated doses till it occasioned salivation, which he endeavour- 
ed to keep up by administering the same remedy occasionally. 
The consequence was an increase of pain in the thorax with 
an expectoration of very fetid purulent matter from the lungs, 
and a constant flow of bloody saliva from the mouth with an 

2S 






178 

incessant fever and dyspnoea, which very soon put a period to 
her life. 

A similar event was produced by salivation in Mr. J. T. 
of Philadelphia in the summer of 1810. The mercury was 
employed cautiously both internally and externally after all 
inflammatory symptoms had subsided, and the expectoration 
of purulent matter had become free. As soon as the gums 
swelled and salivation began to appear, the pain in the thorax 
accompanied with a quick, hard, small pulse and incessant 
racking cough, with expectoration of thin frothy mucus, mix- 
ed with blood, returned, which required bleeding, purging, 
and blistering to subdue. After which the purulent expecta- 
tion with the night sweats and debility returned and increas- 
laily, put a period to the existence of the patient much 
er than there is any reason to suppose would have been 
fe case if no mercury had been employed. 



OF THE CATARRH. 



The catarrh is placed by Br. Cullen in that order of 
diseases denominated profluvia, and is known by an increased 
secretion o^ mucus, from the glands of the mucous membrane 
which line^ the nostrils, fauces and bronchiae, attended with 
more cr less pyrexia, and always with some cough. 



\7\) 
This disease has been frequently treated of uruU r the title 

. h, but though ■ COttgh :ilw;i\ the 

fforra of catarrh which is occasioned In the increased 
tlOll of mucus fronf the bronchia:, it is so often a symp- 
of other affections that are verj diffi rent from one ano- 
ther, that it is improperly employed Vis a generic title. 

u rally begins with some difficulty of 
breathing through the OOse and a sense of fullness, attended 
With some obtuse pain and sense of weight in the forehead, a'" 
well as tome difficulty snd uneasiness in moving the eyes. 

These symptoms are sometimes at their commencement, 
and always soon after, attended with the distillation of a thin 
fluid from the nose, and sometimes from the eyes, which ap- 
pears to be somewhat acrid both by the taste and by its fretting 
the parts over which it passes. 

AVith these svmptoms there is commonly a sense of lassi- 
tude over the whole body, and the patient is sometimes affected 
with sensations of cold or shudderings, especially upon expo- 
sure to air a little colder than ordinary. The pulse also 
generally becomes more frequent and the skin hotter towards 
evening. 

These symptoms seldom continue long before they are 
accompanied with some hoarseness, and a sense of roughness 
and soreness in the trachea, and with some difficulty in respi- 
ration, attended with a sense of straightness in the thorax, and 
a cough which seems to arise from some irritation felt at the 
glottis. 

The cough is generally at first dry, occasioning pains about 
the chest, and more particularly within the anterior part 



180 

thereof. Pains resembling those of the rheumatism are also 
frequently felt in several parts of the body particularly about 
the neck and head. 

The appetite is at the same time impaired, and the patient 
is more thirsty than usual. 

These symptoms however, do not continue long with the 
same degree of violence. The excretion of mucus which at 
first was thin and brought up with difficulty, gradually be- 
comes thicker, and is brought up more copiously, and with 
less frequent and less violent coughing. The hoarseness and 
soreness of the trachea, and the febrile symptoms, abate at the 
same time, and the cough becoming less frequent, and the 
expectoration diminishing without return of pain, the disease 
soon after commonly ceases altogether. 

"When the excretion becomes copious and is brought up by 
coughing of a thicker consistence and yellowish colour, it is a 
sign the inflammatory affection is giving way ; but when the 
excretion is very profuse, is frequently brought up by cough- 
ing, and is accompanied by a difficulty and quickness of respi- 
ration, it is an indication of great laxity, atony, and dilatation 
of the exhaling vessels. , 

Such is generally the course of this disease, which is com- 
monly neither tedious nor dangerous. 

It is now almost universally admitted, that Dr. Cullen 
erred in placing Catarrh among the Profluvia, and that it 
ought to be considered as an inflammatory affection of the 
mucous membrane, lining the nostrils, fauces, trachea and 



181 

[] ce it ought agreeably to the rulei of V 
. to precede the peripneumony and pleuri 

This inflammation frequently terminates in a train of symp- 
toms, much resembling those of phthisis pulmonslis, hut out) 
generally be distinguished from phthisis by the circumstance 

of patients in extreme debility and emaciation, consequent to 
bronchial inflammation, being able to distend the chest to its 
full capacity without feeling much uneasiness, and not any 
pain, because the substance of the lung is not diseased. They 
lie down in hod more easily than consumptive patients j haw 
no shooting pains in the chest, and though they sweat, there 
is nothing like that profuse discharge from the skin which 
accompanies the solution of the hectic paroxysm. — But the 
appearances of the expectorated matter can by no means be 
exclusively depended upon. — See Badham's Observations on 
Bronchitis 1808. 



CAUSES. 

The particular cause of catarrh, is exposure to a colder 
temperature, after being heated or fatigued, and especially 
when both these circumstances concur. 

In many persons after frequent recurrences of this com 
plaint, the sympathy between the vessels of the skin and those 
of the mucous membrane of the fauces and bronchiae fre- 
quently become so remarkable, that a cough attended with 
expectoration of thin gleety mucus is immediately brought 
on by only wetting the feet and letting them remain damp, or 
by sitting a few minutes in a damp or cooler apartment than 
ordinary. In these cases the complaint instead of being 
brought on by subsequent and sudden exposure to a hotter 
temmraturo as taught by Brown, Beddoes and Garnet, is 



182 

almost invariably prevented by it, especially if the instant* 
these effects are perceived, the patient puts his feet into warm 
water, and takes a few draughts of any mild warm liquid, that 
is grateful to the palate ; and more especially if he takes an 
anodyne at the time of going to bed, and lies under a suffi- 
ciency of warm covering to favour perspiration. This is a 
fact which I have witnessed in numerous cases, as well as 
repeatedly in my own person. 

When the inflammation of the mucous membrane has taken 
place, the system is in a very different condition, and requires 
to be treated in a very different manner. In this circumstance 
it bears a striking analogy to the intermittent fever, in the cold 
stage of which the remedies which are highly beneficial, are as 
pernicious in the subsequent hot stage or exacerbation of the 
paroxysm. — For want of attention to these circumstances, Dr. 
Beddoes has fallen into a dangerous error in the treatment 
which he recommends for preventing the formation of 
catarrh, after exposure to its usual causes, after having been 
previously heated by exercise and artificial heat, &c. viz. to 
remain in an atmosphere of very little higher temperature, 
than that to which the patient has been exposed, with the view 
of preventing the formation of the disease. 

The proximate cause of catarrh, is evidently an inflamma- 
tion of the mucous membrane of the bronchiae, the effect of 
which is an increased circulation of the blood in the vessels 
on the surface of the bronchiae, and an increased secretion of 
mucus. When the membrane which lines the nostrils is affect- 
ed in a similar manner, the disease is called coryza. — A cer- 
tain degree of inflammation occasions a free discharge of 
mucus from the bronchiae ; while an increased inflammation 
of the surface of those parts not only suppresses secretion 



183 



of fullness of the lungs, un- 
ation, and quickness of the pulse.* 



TREATMENT. 

The indications of cure in general, are to diminish the action 
ie heart and arteries, and to remove the irritation in the 
respiratory passages. 

These intentions are most certainly accomplished by vene- 
ion proportioned to the state ot pain and feverish heat; 
by the frequent exhibition of mild purgatives ; by the gradual 
introduction of cool air ; by the use of cold aqueous drinks, 
and by the observance of every other part of the antiphlogistic 
regimen, and the avoiding of acrid and indigestible substan- 
ces;! and when the violence of the inflammatory symptoms, 
the pain in the head, heat and restlessness, and pain in the tho- 
rax from coughing have abated, the cure may be considerably 



* Those who regard the preservation of their health and the vigour of whoso 
frame is yet entire, should carefully avoid making effeminate indulgence 
necessary to their comfort ; and by gradually training themselves to bear the 
impressions of cold, endeavour to induce that enviable state of hardiness, 
that will enable them to brave with impunity the vicissitudes of the atmos- 
phere of our climate. This they will, in a great measure be able to accom- 
plish, by living- in cool rooms — by accustoming themselves to regular exercise 
in the open air during the colder months, by habitual co'd bathirig, avd by 
abstaining from the -use of large quantities of warm enervating liquids. Per- 
sons whose constitutions are delicate and readily susceptible of catarrh, 
should never remain inactive, either in the open air or in cool apartments 
long enough to induce an unpleasant sensation of cold or chilliness 

f Cheese, nuts, and every thing that stimulates the glottis and fauces in 
deglutition, or proves indigestible after being received into the stomach, 
should be carefully avoided, as they generally increase the cough 






184 

facilitated by the exhibition of a small portion of an antimonial 
emetic, which may be taken in the following manner. 

§>. Tart, emetic, (now called antimonium tartarisatum, of 
the London College), grs. ij. 
Aqua? fontanse cochliaria. magna, octo. vel §iv. misce. 

Let the patient take one table spoonfull of the above every 
hour, with weak chamomile tea, gruel, or barley water, till it 
has some sensible operation either by vomit, stool or perspi- 
ration, and let him repeat the same every day or every second 
day towards evening, as circumstances may require, in the 
same manner, till the expectoration becomes free and easy. 

One drachm of vinum antimoniale taken in the same man- 
ner, will answer equally well with the tartar emetic. 

Mr. White in his popular essay on the disease termed " A 
Cold," Philadelphia edition, published in 1 808, says, the re- 
medies (in the incipient stage of this disorder) which he can 
venture confidently to recommend, are frequent draughts of 
cold fluids, combined with nauseating doses of emetics— and 
adds that he had often seen a glass of cold water taken upon 
going into bed, warmed with a pan of coals, on which a little 
coarse sugar had been previously sprinkled, afford very evident 
relief. 

If after the use of a nauseating solution of tartarised anti- 
mony in water, for a day or two, the skin continues dry, Mr. 
"White advises the following saline draught to be joined with it. 
§». Sal. tartar. 9i. 

Succ. limon. recent. Jss. 
Tinct. opii. gutt. x. 



ItiJ 

Mr. the acid and alkali together^ and 

idd tin- laudanum, and mii it with a draught 
of the weak emetic solution, which the patient is to take at a 
. hours* 

\N i i • lammatory symptoms s i to create 

a suspicion of their proceeding to a greater extent than is 

compatible with safety, blisters should be applied to each side 

of the th across the sternum without delay, and the 

remedies useful in pneumonia, employed* 

Anodyne* have been observed invariably to increase the 
restb dyspnoea, and sense of distension in the head and 

thorax, while the feverish heat was high ; but as soon as that 
has subsided, and the cough appears to be excited in conse- 
quence of the exquisite irritability of the excoriated membrane 
of the trachea and bronchiae, they are perfecdy safe, and in 
general afford more certain and speedy relief than any other 
remedy. 

" Manv writers appear not to ha\ e been aw are that the bad 
effects produced by opium in inflammatory affections, are 
owing to its increasing the vis a tergo, or the propelling force 
of the heart and arteries. — When this has been sufficiently 
reduced by depleting and antiphlogistic remedies, and there 
is consequently little or no hardness or tension remaining in 
the pulse, opium may be employed to allay pain and irrita- 
tion, and particularly that uneasiness and frequent coughing, 
occasioned by the stimulus of excreted mucus."*... A P. Jf^Iso?:, 

A plaster applied to the chest, composed of diachyl. cum. 

gum. with the addition of opium and powdered camphor, also 

contributes to ease the cough, by irritatin.e and increasing the 

action of the vessels en the surface. 

24 



186 

The pectoral decoction, almond emulsion, barley water, 
with gum arabic dissolved in it, and sweetened with sugar or 
syfjp of capillare, lintseed, quince, or marsh mallows tea, 
lemonade, sago, oatmeal gruel, &c. all make suitable drinks, 
and after the inflammatory symptoms have subsided, and the 
expectoration has become free and copious, they should be 
taken moderately warm, but in the early stage of the disease, 
before the expectoration has become free and easy, they 
should always be taken cool, or rather quite cold. 

Lemonade and other subacid drinks are also proper ; for 
instead of increasing the cough by their acidity, they diminish 
it by their laxative and diuretic, and consequently sedative 
effect. 

The following mucilaginous paregoric is singularly service* 
able in cases of thin gleety expectoration, unaccompanied with 
fever. 

I$j. Elix. paregoric. |j. 
Vini. antimonii. §ss. 
Mucilag. gum. arab. 
Succ. glycirrh. ana. gss. 
Aquae fontanse §viii. misce. 

The common dose is a table spoonfull, to be taken with any 
agreeable tea or phthisan, every three or four hours, or as 
often as the symptoms may require. 5j. of L. laudanum may 
be substituted in the above mixture for the paregoric elixir 
with advantage. 

An electuary made by mixing the mucilage of §um arabic, 
loaf sugar, and fresh oil of almonds together, is also frequently 
found serviceable in allaying the irritation in the fauces and 
trachea in every stage of this complaint. 



ted juice of Spanish liquorice, an infusi 
liquorice root and flaxseed, hav< en frequently enu 

ployed with apparent advantage Cot the same purpose* To 
alla\ i teazing cough, unaccompanied with pain or fever, the 
Following may be prescribed. 
§>. Ol. afrnygdal. recent. 311. 
Mucilag. 511m arabic Jss. 

alba. 5j- 

LSI com. Jij. m. f. haust sumend. pro re n:tu. 

After the removal of the inflammatory symptoms, the 

ted parts are left very irritable, which renders the patient 
liable to frequent relapses unless he is veiy particular in 
accommodating his clothing to the state of the weather, and 
to invigorate the whole system by going frequently abroad in 
the open nir in dry weather. 

Dr. Cullen in his Materia Mcdica, observes, that u ca- 
tarrhal affections often. depend upon an undue balance of the 
system, that is upon a languid perspiration necessarily produ- 
cing a more copious determination to the lungs, and this by 
occasioning an increased secretion of mucus is attended with 
much coughing. In many persons this is habitual, or is rea- 
dily renewed upon ever}' slight application of cold. Whenever 
therefore, there is much coughing, and little fever, opium 
may be employed with safety and advantage." 

M. M. Art. Opium. 

Dr. Darwin remarks, that " when the sanguiferous system 
is full of blood, the absorbents cannot act so powerfully, as the 
progress of their contents is opposed by the previous fullness 
of the blood vessels, whence stimulants in that case increase 
the action of the secerning system more than that of the absor- 
bent one, but after copious evacuation this resistance tb the 



» 



188 

progress of the absorbed fluids is removed, and when stimu- 
lants are then applied they increase the action of the absorbent 
system more than that of the secerning one ; hence opium 
given in the commencement of inflammatory diseases destroys 
the patient, but cures if given in very small doses at the end 
of such diseases." He accordingly directs after the blood- 
vessels have been sufficiently depleted, and the pulse gives the 
sensation of softness ; six drops of tincture of opium, or one 
fourth of a grain of solid opium an hour or two before the 
usual exacerbation of the symptoms, which is generally to- 
wards evening, 



OF THE INFLUENZA, 

OR 

EPIDEMIC CATARRH. 



This disease does not occur in this country every year, or 
at regular periods, but after very irregular intervals and un- 
certain periods ; and, from its occurrence at different seasons, 
and under very different states, of temperature, it is not pro- 
bable that the sensible qualities of the atmosphere have any 
share in its origin or generation, or much share in its propa- 
gation. 

It appears from a collection of historical facts published in 
the third volume of the London Medical Transactions, that 



urred md spri id ovtx i groat portion of the 
rldin the years 1510, 1557, 1580, 1587,1591,1657,1! 
t, 1775 and 171 

It appears from Mr. W< ter'a II. ; of Epidemics, that 
influenza was prevalent in America so early as the j 

r, and that it was again epidemic in New England, in the 

ad that in the year last mentioned it begun in the 
ith of June. — (Vol. I. p. 189.) 

Dr. Gilchrist, in his Observations on the Influenza, pub- 
lished in the third volume of the Physical and Literary Esj 
of Edinburgh, states, that it was prevalent at Edinburgh in 
die year 1 729, and that it began in the winter. He says this 
disease increased the bills of mortality at London for some 
time, to about one thousand a week. — " The weather at that 
time was thick, warm and rainy." 

It again made its appearance at Edinburgh about the 1 7th 
of December, 1732, and continued to spread there till Janu- 
ary, from which time it rapidly decreased, and ceased entirely 
by the end of the month. — u It had been previously epidemic 
in Saxony and Hanover, and other neighbouring countries in 
Germany in the month of November." 

" It appeared in London and Flanders, after the first Week 
of January, 1733 — In Paris, it appeared about the middle, and 
in Ireland about the end of January — At Leghorn, about the 
middle of February, and at Naples and Madrid, near the end 
^f the same month." 

u It made its appearance in America about the middle of Oc- 
tober 1733, and was first observed in New-England. It was 
w>on afterwards observed in Barbadocs and Jamaica, and was 



V 



190 

also reported to have made its appearance in Peru and Mex- 
ico, in South-America."-— (See Edinburgh Medical Essays, 
vol. ii.) 

Dr. Rutty in his account of the weather and diseases of 
Dublin, relates that the influenza of 1732-3 appeared in Dub- 
lin towards the latter end of winter. That which occurred 
in 1737, made its first appearance in October, and that in 
1743 in May ; and that in the year last mentioned it was ob- 
served first at Rome, where it carried off great multitudes, as 
it did afterwards in Spain. It had been epidemic at London 
a month before it was observed in Dublin. The prevalence 
of this disease and its having spread over the chief part of 
Europe in the vernal season of 1743 is mentioned by Dr. 
Huxham in his Observations on the Air and Diseases of Ply- 
mouth. Dr. Whytt in a letter to Dr. Pringle mentions the 
prevalence of the influenza in Edinburgh and the South of 
Scotland in the year 1758. 



There are no records of the occurrence of this dis- 
ease in America that I have met with from 1733 till the year 
1 749, and I only have the account of its being epidemic or 
general at that time from tradition, having seen no printed 
account of it ; nor is there any recollection by the ancient in- 
habitants of Philadelphia of its occurrence from the period 
last mentioned, until the year 1761 ; at which time, according 
to the report of the late Dr. Thomas Bond, it was traced 
from the West-India islands to Halifax, where it made its 
appearance in the spring, and from thence was conveyed to 
Massachusetts and the neighbouring states, and afterwards 
spread in a rapid manner over all the inhabited parts of North- 
America without being retarded in its progress by any 
changes in the sensible qualities of the atmosphere, or in the 
course of the winds till the month of July ; from which time 



191 

i more lie. ml of inthi nil ihe Jrear 1789; 

at least I have not been abk to di .iy printed docu- 

ments of its existence within th ids* 

Dr. Gilchrist observe; that in the year 1762 the influenza 
uly in England from South to North, and in 
Scotland was most general in the month of June, though 
spasmodic cases had been observed as early as April. 

Dr. Monro in his Account of the Diseases in the British 
/mils in (.iertnany, relates " that at Bremen after a very 
re winter, the weather from being very cold became of 
a sudden extremely hot about the 10th of April 1762, and 
that a few days after many persons were seized with a very 
violent catarrhal disorder. a accompanied with pains in the 
breast, head, limbs, and all over the body," and that a similar 
disorder was epidemical in most countries of Europe at the 



For the history of its appearance and progress in Europe 
in the year 1782 the reader is referred to the communications 
of Drs. Hamilton and Fothergill, published in volume second 
and third, of the Memoirs of the London Medical Society. 

In the year 1 789 it made its appearance in New-York early 
in September, and in Philadelphia the latter end of the same 
month ; to the latter of which it was supposed to have been 
brought by some of the society of Friends, who came to 
attend their yearly meeting; soon after which it spread 
over all the southern states, and to the army in the "West- 
ern Territory under the command of General Wayne. 
According to the reports of the public prints, the disease 
did not reach Boston for some time after it had become 
ver) general at New-York. Its first appearance in Jamaica 






» 



192 

the year last mentioned was about the 20th of October, near 
a month after its appearance in Philadelphia, and according 
to the testimony of Drs. Chisholm and Read it did not ap- 
pear at Grenada till November, and at St. Lucia till towards 
the close of December. See Duncan's Commentaries, vol. 
xvth and xviith, and Dixon Read's Diseases of the Army. 

The disease again made its appearance in Philadelphia in 
the early part of the summer of 1793, but had nearly sub- 
sided when the yellow fever made its appearance the latter 
end of July and beginning of August. It did not spread very 
generally that year. 

Towards the end of the year 1802 this disease made its 
appearance in different parts of Europe in succession. " In 
Paris it Was epidemic or very general, some weeks before it 
made its appearance in London, and did not reach Manches- 
ter till the March following. It soon after proceeded to differ- 
ent parts of Scodand. The circumstances accompanying its 
introduction into Edinburgh and the manner in which it was 
propagated as related by Dr. Duncan of that city, carry irre- 
sistible evidence of its having been communicated by conta- 
gion, whatever circumstances first gave origin to it. The 
ninth volume of the London Medical and Physical Journal 
also contains some well attested facts and powerful argu- 
ments in support of the opinion that the imluenza is a conta- 
gious disease. 

The influenza became epidemic iii the United States again 
in the year i 807. 

It made its first appearance this time as it had done in the 
year 1789 in New- York, and existed there in 1807, two weeks 
at least before it was noticed in any other part of the United 

States. 



it had made vtry little i I in Philadelphia on tin- l 

\ ist, at which time it appears, from Dr. Ricketson' i 

int published in our of the Neil York newspapers, that 

• I one hall" of tlu- inhabitants of that city were then or 
had been lately affected bj it. 

It has been reported that it waa epidemic at Halifax l>< I 
it made its appearance at New-York ; the truth of this report] 

however, 1 have not hitherto been able to ascertain with eer- 

taint\ . But the bills of inquiry taken at the Lazaretto pi 
that it waa epidemic in the Cape de Verd Islands, which arc 
situated near the coast of Africa, and belong to the Portugu* 

several weeks before it made its appearance in this countn . 

It appeared at Princeton, New-Jersey, about fifty-eight 
miles south-west from New- York, on the post road to Phila- 
delphia, about the same time that it appeared at Philadelphia, 
though but few cases occurred at Princeton till the 20th of 
the same month. — (See Philadelphia Museum, vol. V.) 

I received information by letter from Dr. Smith, dated the 
18th of August, that the influenza had but just begun to make 
its appearance at Wilmington, (Delaware), at that date ; and 
Wilmington is only twenty-eight miles from Philadelphia, in 
a southern direction. 

Dr. Stearns states, that the first case of the influenza that 
occurred at AVaterford, Saratoga county, in the state of New- 
York, was on the 7th of August ; and that it had been pre- 
valent some days sooner at Albany, which is situated ten 
miles south of Waterford, on the west bank of the North, or 
Hudson's river, one hundred and sixty miles to the north of 

* Dr. Dancer, in his Jamaica Practice of Physic, mentions its appear- 
ance in Jamaica in 1807, but has omitted to mention the date of its appear- 
ance there. 



fli 



194 

the city of New-York, from whence it was introduced into 
"Waterford by persons who had been attending the courts at 
Albany. Mr. James, who was the first person attacked with 
the disease, had taken lodgings in a family consisting of fif- 
teen persons ; some of these occupied stores in different 
parts of the village. Excepting those who had taken the 
disease at Albany, the members of this family were the first 
affected. " If the cause of this disease had been wafted by 
the winds, it is highly reasonable to suppose that it would 
have been simultaneous in different parts of the village, and 
not have commenced with a single family, and that in a pub- 
lic house in the northern part of the village, instead of begin- 
ning in some of the families in the southern part, as it was 
more in the direction of the wind, which prevailed at that 
time, and which had proceeded in that direction for a considera- 
ble time before the disease made its appearance in that place." 

According to Dr. Spalding's account annexed to his bill 
of mortality for the city of Portsmouth, (New-Hampshire), it 
did not make its appearance in that city till about the middle 
of August, and it did not disappear till the middle of 
December, which is the season when common catarrhs are 
most prevalent. 

The editors of the New-York Medical Repository, in the 
second number of the fifth volume, and second hexade, men- 
tion that a correct observer, who left New- York for the Pro- 
vince of Maine, on the 20th of August, found on his arrival 
at Newport (R. I.) that the influenza had just begun to make 
some progress there, and that the people of Boston had begun 
to complain of it, but that it had not made its appearance at 
Kennebeck at the time of his arrival there on the 30th of Au- 
gust, though it was observed there a few days later. 



It is stated in the Fifth Volume of the Philadelphia fcl 
cal Museum, thai it made its appearance in Rockingham 

COUnty, Virginia, about two hundred and Sixty mill s in a 

southern direction from Philadelphia, about the > s, h of Sep- 
tember. At Edenton, North Carolina, the latter end oi* 
September, and that it did not entirely disappear there till the 
end of the > ear. 

Dr. Cravens, the partner of Dr. Peachy Harrison, and Mr. 
B. Smith returned from a journey to Tyger's Valley, about 
a hundred miles distant from Harrisonburgh, the county 
town of Rockingham, on the evening of the fifth of September. 
On the 8th, Dr. Cravens was attacked with the influenza, 
and Mr. Smith the following evening. They had seen no 
person with it on their journey that they knew of, nor after 
their return, though it was at that time prevalent at New 
Market, about eighteen miles from Harrisonburgh. 

No other person was affected with the disease in either the 
village of Harrisonburgh or the surrounding country till the 
11th, when Dr. Harrison, who had visited both of the gentle- 
men before mentioned, was attacked with the same disease. 
But in a t^w days the cases multiplied so fast, that the Doctor 
could not trace their source any farther. 

It is related in the Fifth Volume of the Medical Repository, 
(hexade second) that the members of congress from Georgia 
and South Carolina did not meet with the influenza on their 
journey, till they arrived as Raleigh in North Carolina, 
(which is about four hundred and fifty miles in a south-west 
direction from Philadelphia,) about the 17th or 18th of Oc- 
tober, though it appears from a letter which I received from 
Dr. Harris of Charleston, that it made its appearance in that 



11>6 

city the beginning of October, at the same time that the 
yellow fever was prevalent there. 

Dr. Kollock of Savanna, in a letter dated March 7th, 1 808, 
informs me that it was not observed in that place till about 
the 26th of October ; and adds that " though none died of it 
in that town, many died of it in the interior parts of the state, 
where in some instances it swept off whole families." 

The members of congress from Tennessee first observed it 
at Staunton, about the same time as the others did at Raleigh. 
Several gentlemen from Kentucky were at the Hot Springs 
on the 16th of October, at which time the inhabitants were 
free from it. One from Chilicothe in the state of Ohio, ob- 
served it at Hockhocking on the 12th of October. Some of 
those gentlemen suffered from the distemper on their journey, 
while others were not affected by it till after their arrival at 
the seat of government. 

It did not make its appearance in Warren county, state of 
Kentucky, till the last week of November, according to Mr. 
Sharp's letter published in the Medical Museum, Vol. 5th, 
page 113, 

Though the influenza had spread rapidly in Philadelphia, 
from the 12th of August, no person within the inclosure of the 
Lazaretto, which is only twelve miles in a southern direction 
from Philadelphia, was attacked by it till the 20th of the 
same month, and then it firs^t attacked the quarantine mas- 
ter, captain Egger, two days after the arrival of a pilot by the 
name of Robison from Newcastle, who was ill with it at the 
time of his arrival at the Lazaretto. Soon after the attack 
of captain Egger, almost every person belonging to the Laza- 
retto, became affected with the same disease. This informa- 



i from tlu- Late Dr. Bw htato, who was at that 
time physician of that institution. 

On the 80th of August, Mrs. A. while indisposed with the 
influenza, went from the city to see her Bick child at Mrs. 
\\ cis'a on the Germantowf road about five miles from Phi- 
ladclphia, at which time every person in the house was in per* 
Feet health, excepting Mrs, \. infant child, and that had a dif- 
Qt complaint. On the 23d Mrs. A. \s mother, who had been 
a considerable time from the city, was attacked with the influ- 
i, and on the 2-4 th the woman that nursed the sick child, 
and on the 25th a lad}- who resided in the country near Mrs. 
AVcis's, and who had not been in the city for more than a 
month, but who had set in the same chamber with Mrs. A. 
for some time on the day of her visit to the child. They all 
three had the disease in a very violent manner. 

Mrs. W eis's family which had no intercourse, or access to 
that part of the house which was occupied by the sick child and 
the persons already mentioned, escaped the disease for seve- 
ral weeks, as I have since been informed by Mrs. Weis. 

It is true the disease had made its appearance in different 
parts of the country, before Mrs. A. visited her child at Mrs. 
Weis's, most of whom upon inquiry I found had been into 
the city to market or on some other business ; but I am certain 
that the persons who took the disease at Mrs. Weis's after Mrs. 
A.'s visit, had had no intercourse with any other person with 
that disease, for I attended them during their illness and made 
the most careful inquiry respecting it. 

This disease made rapid progress in Philadelphia, after its 
first appearance, came to its heighth about the beginning of 
September, declined rapkjly soon after the middle of thai 



198 

month, and was entirely extinguished before the end of Oc- 
tober. 

The number of deaths by it in Philadelphia, the Northern 
Liberties, and the district of Southwark, reported to the 
health officers, was only thirty : 0£ which number three were 
under two years of age, six between fifty and sixty; four be- 
tween seventy and eighty; and three between eighty and 
ninety.* 

* According to Dr. Ramsay's account of the influenza in his History of 
South Carolina, volume second, page 90, one half of the inhabitants of 
Charleston, amounting to about fourteen thousand persons, were attacked 
by the influenza in the autumn of 1807, of whom forty-five including thirty- 
two negroes died. He asserts that it originated in New-York ; and spread 
from that center in all directions. "It reached Canada in October, and ex- 
tended to the western and southern states, and even to Havanna, in the 
course of three months." Its rise and progress is ascribed by Dr. Ram<- 
say to some morbid constitution of the air. He also entertains the same 
opinion relative to the origin of the yellow fever, though the one spreads 
rapidly over every inhabited part of the country, while the other is chiefly 
confined to the limits of a city or seaport town. 

Dr. Ramsay has certainly been misinformed, or labours under some ex- 
traordinary prejudice with respect to the mortality by the yellow fever in 
Charleston in different years, and with respect to the exemption of the na- 
tives from the disease ) unless they all desert the city, on the first report 
of its existence. He is also extremely inconsistent in ascribing a wide 
spreading disease, and one confined within specific limits to the same 
cause. That such errors in point of fact, and such inconsistent opinions, 
should be delivered by a historian of Dr. Ramsay's talents and acquire- 
ments, can only be accounted for from a presumption that he has not had a 
sufficient number of favourable opportunities of observing the rise and pro- 
gress of those diseases himself, but has been imposed on by the reports of 
certain visionary theorists, or by a description of men, whose aim is to pro- 
mote their own selfish and unworthy views at the expense of the public 
safety. 

They who oppose arguments and conjectures to well authenticated facts 
and observations, however they may satisfy unreflecting credulity, can only 
expect to meet with the sneer of contempt from those conversant with the 
law of evidence and the rules of fair and correct reasoning. 



199 

In the course of the seventeenth century, when the plague 

•quentlv vi-nu d England, tin- influenza only occurred 

. in the \ ear 16JT, when as ii has visited that coun- 

i or eight times since the last appearance of the 

plague there. 

Notwithstanding the authenticity of this fact, Mr. Webster 
in his history of epidemics gravely asserts that the influenza 
and the measles are the usual precursors of the plague. 

Several eminent physicians are of opinion that the influ- 
enza is propagated over large portions of the globe by certain 
miasmata, or noxious particles contained in the air. 

The numbers attacked by this disorder at the same time, 
and the extensive sphere of its activity, are circumstances 
which seem to favour this opinion. But when we consider 
the confined operation of the atmosphere^ in conveying infec- 
tious or noxious particles, and how soon they are dissipated, 
or rendered inert by diffusion in, or admixture with, the at- 
mosphere, it renders the opinion extremely equivocal ,• and 
what renders it more so, is the successive manner in which it 
proceeded from one place to another and particularly from 
the length of time that elapsed between its appearance at 
New-York, in the year 1789 and 1807, and several of the 
cities and towns to the northward, westward, and south- 
ward ; a circumstance which, in my opinion, affords suffi- 
cient evidence that the disease, however it originates, is pro- 
pagated by contagion, but of a nature more active in its opera- 
tion, and more extensively diffused, than is observable in anj r 
other contagious disease at present known. 



200 

If its cause had existed in the atmosphere to any extent, or 
had been occasioned by any morbific constitution thereof, all 
the inhabitants in the same latitude, or at least in the direction 
of the prevailing winds would have been affected at the same 
time, or within a very few days of each other, allowing for 
difference of constitution and the time it takes for the wind to 
pass from one place to another ; but as this was not the case, 
and the disease appeared successively in different cities and 
towns in different directions, its appearance can only be ac- 
counted for by the doctrine of contagion : for a disease deri- 
ved from so general and extensive a cause as the contamination 
of a large portion of the atmosphere must necessarily have 
produced corresponding effects. 

A long continuance of warm, calm and misty weather pre- 
ceded the appearance of the influenza in Philadelphia in the 
year 1789, whereas the season previous to and during its pre- 
valence in 1 807 was much more rainy and cooler than it had 
been known at the same season for several years. 



An Account of the Symptoms of the Influenza as it 
appeared in Philadelphia in the Year 1807. 

In general, symptoms of catarrh and coryza preceded the 
fever. 

Many complained of a sensation of soreness within the 
thorax, and pain on coughing, especially in the frontal sinuses 
or in the eye balls. In these cases the pulse was always fre- 
quent, and generally hard or tense, and the skin dry, except 
during the act of coughing. The eyes were also frequently 



t 

.ind Inflai od painful ; and with 

i the disease appeared to be confined to the eyes only, to 
the exclusion of the other symptoms. In some the pain 
the loins and limbs \\ raely acute, accompanied with 

i lassitude, or a feelin mbling verj great fatigue 

from too much exertion. 

When the local affection was accompanied with acute pain 
the thorax or side, the COUgh was distressing, 
and almost incessant, and the expectorated matter scanty, 
white and tough. 

When the inflammation was more superficial and mild, the 
expectoration was more copious and free, and the cough less 
frequent or distressing. 

In affections of the. mucous membrane of the nares, fauces 
and bronchia?, a superficial inflammation of their surface occa- 
sions a copious secretion of mucus, whereas when the inflam- 
mation affects their deeper seated vessels, no mucus is secreted 
till that high state of inflammation subsides, or is considerably 
diminished. The same effect is observable in every Other 
secreting surface. 

With several old people the disease commenced with symp- 
toms of lethargy and prostration of strength, which no reme- 
dies that were tried could relieve. 

In several pregnant women, the disease resembled the 
pleurisy, and was relieved by the same remedies as are most 
efficacious in that disease, 

In many persons the disease assumed the appearance of the 
rheumatism, and in persons accustomed to the pout it produ- 



263 

ced gouty symptoms. Several persons exposed in thin 
clothing, to the sudden changes of temperature, which occur- 
red during the prevalence of the disease, and particularly 
immediately after their recovery from the influenza, were 
attacked with a renewal of catarrh, and some under similar 
circumstances were attacked with the dysentery, by which 
they suffered very severely. 

All old strains and chronic diseases were aggravated by it, 
and many fell victims to phthisis pulmonalis, in consequence 
of its effects upon the lungs, who had been predisposed to that 
relentless foe to life* 

In general, though it spread more readily and rapidly 
among the tenants of the nursery when introduced into a fa- 
mily, children were affected much more mildly by it than 
adults, and women than men, those in a state of pregnancy 
excepted, 

TREATMENT. 

This disease required blood letting, and other depleting 
remedies, and the antiphlogistic or cooling regimen to be em- 
ployed with more or less strictness and attention, in proportion 
to the greater or less degree or violence of the existing in- 
flammation and fever. Small and repeated doses of nitre and 
tartar emetic or antimonial wine, were usefully employed, 
during the intervals from purging. 

As soon as the pain and fever were subdued, a few drops 
of laudanum and antimonial wine in a mucilaginous draught, 
taken three or four times a day, or a pill containing one 
sixth or one fourth of a grain of opiiun, and one grain or 
one and a half of pulv, ipecacuanha, or one fourth of a grain 






203 

i.ir, ni the lame stated periods, fallowed l>> a 
of barley, liquorice root, snd ami nr, <>i .my 

agreeable mucilaginous tea or infusion; observing ta in* i 
quantity of the o bed time, and to favour mild 

ion. illy bathing tin feet in warm H 
If the pain or uiv thould return in the thorax or head, 

il bleeding should be advised, ami a blister applied to the 
part most affected. Recourse should be had at the same time 

nail and repeated doses of antimonials. But when bleed- 
inland purging were employed earlv in such cases as required 
ind the antiphlogistic regimen strictly observed, I seldom 
found the application of blisters necessary. 

Many indeed had the disease so mildly, that they had no 
occasion for any remedy, but pursued their usual occupations 
without much inconvenience. 

Nauseating doses of antimonials, served to subdue the 
inflammation and fever in mild cases, after a purge, or a few 
doses of common sulphur mixed with honey, simple syrup, or 
milk and sugar, without the aid of bleeding, but when the pain 
in the chest was acute, the skin hot, tongue white, and the 
pulse frequent and tense, bleeding could not be omitted with 
impunity. 

Besides the mucilaginous anodyne mixture already men- 
tioned, many took with advantage to allay the cough, a mix- 
ture of oil of sweet almonds, mucilage of gum arabic, and 
svrup of violets, or a sufficient quantity of loaf sugar, while 
others preferred a syrup made of lemon juice, sweet oil, and 
sugar candy, &c. 

The preceding account of the symptoms and treatment of 
the influenza, is taken from the cases and memoranda which I 



204 

had inserted in my note book during the continuance of the 
disease in Philadelphia in the year 1807. The rest of the 
facts and observations, were collected and noted at different 
times previous to that period. How far they are worth the 
trouble I have been at in collecting them, or merit the atten- 
tion of others, must be left to the decision of less partial and 
more competent judges. 



OF THE DYSENTERY, 

OR 

BLOODY FLUX. 



The diagnostic symptoms of this disease are, an urgent, 
desire to go to stool, generally without the ability of dischar- 
ging any thing from the intestines except a little bloody mucus, 
which is frequently mixed with froth or air bubbles. This 
disease is always accompanied with more or less fever, and 
griping or spasmodic affection of the intestines. 

The patient is also generally sick at stomach in consequence 
of the griping which precedes every effort to evacuate the intes-. 
tines. 

The disease is generally preceded by costiveness, flatulency 
and loss of appetite ; and usually begins with alternate sen- 



Id and heat, debility in the animal functions and 

The stools at first are commonly copious and exefementi- 

, but the. next da) or soon after, the) become small in 

quantity and of a frothy appearance, and are attended with 

griping and u • 

Prom this time till the disease takes a favourable change, 

natural feces arc seldom evacuated except during the opera- 
tion of a purge, and then they are generally in small hardened 
lumps called scybala. 

AVhcn a cathartic has this effect, the griping is sensibly re- 
lieved, the stools are fewer and the tenesmus less painful or 
distressing. 

Besides the mucus in the stools, there is generally a watery 
humour resembling serum, which is perhaps one cause of the 
irritation, and descends from the higher parts of the intes- 
tines, whilst the mucus is chiefly secreted from the rectum in 
consequence of great straining. 

Balls of hardened faeces may come away at any time of the 
disease, but are most common in its advanced stage, especially 
when purging has been neglected ; and it is common to see 
tenesmus and all the other symptoms give way after their 
discharge. 

The stools are alone distinguished by a peculiar smell dif- 
ferent from that of common excrements ; it is faint and not 
rank at first, but towards the end, in fatal cases, when the in- 
testines begin to mortify the fector is cadaverous and intolera- 
bly disagreeable. 



2oe> 

The air which abounds at this time in the first passage^ 
often occasions a sense of oppression or increase of the griping 
according to the place where it is collected, whether in the sto- 
mach or in the smaller or larger intestines, and in proportion 
to the spasms which imprison it. In general, the irritation of 
the stomach and higher intestines is attended with more sick- 
ness than griping, and therefore when the griping is most 
acute without sickness, it is probable that the spasm is lower 
down, and when the chief pain is felt towards the os sacrum, 
we may then suspect that the upper part of the rectum is af- 
fected ; but when the lower extremity of the rectum is irrita- 
ted, the spasm seems not then to be so much productive of 
pain as of a violent effort to relieve itself of the irritation, 
drawing into consent, the muscles of that part as well as 
others, which act in discharging the faeces. The evacuation 
of the faeces is always preceded by severe griping, and suc- 
ceeded by some respite ; but the motions being so frequent, 
the patient can have no considerable ease till the irritating 
cause be removed, and the morbid sensibility diminished. 
But when the bowels sphacelate, which is the general issue, 
when the disease terminates fatally within the period of four- 
teen or fifteen days, the patients, though restless, complain 
of little pain or tenesmus ; some remaining free from those 
symptoms not only for some hours, but sometimes for two 
days before death. At such times they have some degree of 
delirium though some retain their senses to the last. 

Dissections shew that the principal seat of this disease is in 
the colon and rectum, the internal coat of which, is always 
more or less inflamed. Hence the morbid appearances, ob- 
served by Morgagni, Pringle, Blane and others, are, in those 
who die in the acute form of the disease, gangrene, and in 
chronic or protracted cases, ulcerations with contractions and 
thickening of the coats of the intestines, with enlargements of 



knott) and protuberant. Tlu 
: .,■ am also lometunea partake* of the inilainmation of the 

al parts. 

eamus generally continues for sonutiii: 
rig has ceas d, owing to the excoriate J state and incre 
ibility of the rectum. 

identia ani, and strangury, frequently occur in this 
. the former from violent straining, and the latter from 
the inflammation spreading to the neck of the bladder. 

The duration and issue of this disease are uncertain. With 
proper remedies and regimen early applied, the disease gene- 
rally terminates favourably ; but from mismanagement or 
neglect, it is frequently fatal. 

When debility increases daily, with a remarkable alteration 
of the countenance ; when the pulse becomes low r , small and 
intermitting, and the patient is very restless and sighs fre- 
quently, without complaining of griping : when his eyes have 
a vacant expression and dim appearance, his mouth and throat 
affected with aphthse, and the stools come away without his 
knowledge, and are of a cadaverous smell, his life is nearly at a 
close and his recovery hopeless. 

A short time before the patient expires, he feels perfectly 
free from pain, and though as cold as marble, he flatters him- 
self that he is better. 

When this disease terminates fatally, the dissections of nu- 
merous practitioners prove that the inflammation has termina- 
ted in sphacelus. 



208 

Among others, that very sagacious and accurate observer Dr, 
Cleghorn, has recorded that u upon opening the bodies of the 
dead, he constantly found the great guts either entirely mor- 
tified, or partly inflamed, and partly mortified ; the rectum 
being generally most affected. In some cases the small 
guts appeared to be perfectly sound in appearance, but more 
frequently their lower parts were inflamed." Hence it is not 
surprising that death should be preceded by symptoms of 
mortification. 

When it terminates fatally, it is frequently in seven or 
eight days; but more frequently about the eleventh or 
twelfth, and seldom after the sixteenth. When the disease 
continues longer than sixteen days, the intestines become ul- 
cerated or schirrous, and it becomes a local chronic affection, 
which sometimes continues in the form of tenesmus and lien- 
tery for years. A case of this kind is related by Dr. Lind* 
in his paper on infection, page 220. 



OF THE CAUSES OF DYSENTERY. 

Many authors of eminence in the medical profession, are of 
opinion that the dysentery is occasioned by the same remote or 
occasional causes as intermittent fevers in conjunction with the 
application of cold to the surface of the body. In support of 
this opinion they appeal to the circumstance of both diseases 
occurring in similar situations, and becoming epidemic about 
the same season of the year ; and from the examples men- 
tioned by sir John Pringle of a number of soldiers, who, after 
having been encamped on marshy, ground, were compelled to 
lie all night in wet clothes without shelter after a fatiguing 
march ; some of whom were soon after attacked with thr 



»me with an intermittent, and others irith r.ymp 
which appeared to partake of both* 

Hut to these (acta there are main- exceptions, as may Ik 
hi v an Bwieten's Commentaries, and several Urtei 

authors. 

In the first place, the circumstances respecting the state of 
the weather, or temperature and changes of the air, which give 
rise to intermittents, are die reverse <>f those in which the 

ntery makes its appearance. The chief circumstances, 
which in low and level situations are most favourable for the 
production of intermittents, are a long continuance of wet 
weather, succeeded by drought and great heat. AVhereas, the 
dysentery never becomes epidemic but when a long course of 
hot and dry weather is suddenly succeeded by cold and wet. 

The disease appears also to be occasioned by different 
causes from the fever which occurs in low, flat and moist 
grounds, as the dysentery frequently prevails in elevated 
situations out of the neighbourhood of marshes, particularly 
in the month of August, when the dews are heaviest. 

The different treatment which these diseases require, as 
well as the contagious nature of the dysentery, under particu- 
lar circumstances, afford irresistible objections to the opinion 
of their being the same in kind, and only differing in degree, 
and consequently to their being derived from the same remote 
causes. 

Sydenham, supposing every species of disease that became 
epidemic, to depend upon some peculiar noxious constitution 
or condition of the atmosphere, independent of changes in its 
sensible qualities, has taken no notice of the weather that 

27 



210 

preceded the dysentery, which was epidemic in London in 
the summer and autumn of 1670, but Willis says the summer 
preceding its appearance was remarkably hot. 

Sir John Pringle relates that, in the year 1762, the sum- 
mer heats and droughts were of longer continuance than he 
had remembered to have seen them in England ; and that in 
the autumn of that year, more cases of dysentery occurred in 
the city of London, than in all the preceding sixteen years 
that he had resided there, — (Diseases of the Army, seventh 
edition.) 

Though I had opportunities of seeing this disease epidemic 
in the month of September, in the year 1776, among the 
American troops on Long Island, and afterwards at Amboy, 
during the very rainy weather which succeeded a hot and dry 
summer. None of the nurses or attendants of the sick in the 
regimental hospitals took the disease. 

In other situations and circumstances however, I have no 
doubt from the testimony of Degner, Lind, Sir John Pringle, 
JBlane, and many other attentive observers, that the disease is 
contagious in confined situations, where ventilation is excluded 
and cleanliness neglected. Degner in particular, has given 
the most convincing reason to believe, that the dysentery 
which prevailed with dreadful and almost unexampled mor- 
tality at Nimeguen in the year 1732, originated from one in- 
fected person brought into that town from some distant place. 
At this time there was nothing remarkable in the state or 
temperature of the season, and none of the neighbouring 
towns suffered, except by their communication with the in- 
fected place. When the question relates to a remote and 
external cause, it is to be understood that however prevalent 
and powerful it may be, it is not sufficient at all times to pro- 



an i (Feci without the coh< urren< e ol .1 , 
sonn litional exciting cause* Bom< 

bowi ope 

i predisposing and occasional cause, without tli 
if an) oth< r. 

u In the camp, the contagion passes from one who is iil 
his companions in the Bame tent, and from thence perhaps to 
the next. — The foul straw becomes infectious* But tl 

f infection are the privies, after they have recei- 
ved tlie dysenteric excrements of those who first sicken. The 
hospitals likewise spread it, since those who are admitted with 
the flux not only give it to the rest of the patients, but to the 
nurses and other attendants of the sick. 

"La general, the contagion does not suddenly spread; for 
whole towns and camps are never seized at once from the 
impurity of the atmosphere ; but the infection is carried from 
one to another by the effluvia, cloths or bedding, &c. of infec- 
ted persons, as in the case of the plague, small-pox and mea- 
sles. Yet the dysenteric miasma is of a less infectious nature 
than any. of those; so that in the milder epidemics it may pass 
unnoticed as in those described by Sydenham and Willis." 

r a patient investigation of the question relative to the 
contagious nature of the dysentery, and comparing the obser- 
vations of all the most approved authors, and examined the 
situations and circumstances in which the disease has been 
supposed to have been propagated by contagion, I am convin- 
ced that like the typhus fever, it is only contagious in situa- 
tions where the air is confined and cleanliness neglected. In 
open situations where the air is free and pure, and cleanliness 
preserved, there is scarcely a well attested instance of its be- 
ing communicated from one person to another. 



* 



212 

That the disease sometimes supervenes after a person has 
been exposed to marsh miasmata, or to febrile contagion, 
there are many examples on record, and in the latter case, 
that it is accompanied with the symptoms of malignant fever ; 
but that it is rendered contagious by such combination as 
taught in a late publication by Dr. Harty, is by no means 
confirmed by my observations, but the contrary. 

It is true, the typhus with which the dysentery is some- 
times combined may be propagated, but the dysenteric symp- 
toms will not accompany it, unless the patient is exposed to 
the operation of cold and wet, for a certain time after he has 
received the infection of typhus. 

The excrements or effluvia of dysenteric patients in con- 
fined, unventilated and foul situations, when volatilized by 
heat, certainly sometimes produce the same specific disease in 
those who visit the patients ; but like the contagion of the 
yellow fever and of the typhus, the excretions or effluvia of 
the sick become divested of their noxious quality when expo- 
sed to and diffused in pure and open air. 

There are many cases described by authors, of patients la- 
bouring under dysentery and typhus fever, as well as of pleu- 
risy and malignant fever at the same time in military and naval 
hospitals ; and of patients with the pleurisy being brought into 
hospitals where the typhus existed at the time, who became 
affected with the typhus soon after the decline of the inflam- 
matory symptoms. And in the Southern States of this 
country, nothing is more common than to meet with patients 
with- symptoms characteristic of the existence of dysentery 
and bilious fever at the same time, produced by the joint 
effects of marsh miasmata, and sudden vicissitudes of tempe- 
rature. 



rHEATMENT. 

to the fallacious indications afforded by tlu 
svinptoms, L shall offer the result of my own experience, and 
the observations of those who have been most CO 
with this difiensti 

the purpose of proceeding with regularity, I shall dib- 
tinguish the dysentery into three states, viz. 

1st. When the disease is recent and the sick can easily bear 
evacuations. 

2d. When the disease is accompanied with violent and dis- 
tressing symptoms, or has continued long, and has greatly 
impaired the strength, inflamed the intestines, and brought 
on a hectic fever ; and 

3d. When the patient is prevented from recovering by the 
continuance of a tenesmus, or some other remains of the 
disease, or becomes subject to frequent returns of 'a 
diarrhoea, from the weakness and morbid sensibility of his 
bowels. 

As there is always more or less inflammation of the mucous 
membrane or villous coat of the intestines in the early or recent 
state of this disease, similar to that which occurs in the bron- 
chia in catarrh, blood-letting in the generality of cases, is an 
indispensible remedy. In regulating the quantity and repeti- 
tion of this remedy however, the pulse, as in cases of enteritis, 
is a very uncertain guide ; for in both diseases it is generally 
small and low ; and when sickness at stomach accompanies 
the disease, it generally appears soft and weak also. But very 
acute, and frequent griping and pain in the abdomen, previous 
to and during every evacuation, accompanied with painful 
unus, are signals for the employment and repetition of 



214 

this remedy. While these continue with severity, blood- 
letting should be repeated to the quantity of ten or twelve 
ounces, and in cases of greater violence, in much lar- 
ger quantity once in six or eight hours, till a manifest abate- 
ment of the local pain and distress is procured. 

In conjunction with blood-letting, a full dose of any of the 
common purging salts, with the addition of one fourth or one 
half of a grain of tartarized antimony, should be administered 
soon after the first bleeding, and the fourth of a full dose every 
four hours after, with the addition of a fourth or sixth part of 
a grain of emetic tartar to each dose, till the fixed pain is re- 
moved, and more copious and natural stools are procured. 

Fomentations of warm water to the abdomen and legs, 
also contribute to mitigate the pain and fever in the early 
stage of the disease. Where they fail, and especially if the 
blood drawn on the second or third time of bleeding shows a 
sizy surface, or firm cohesion of the crassamentum, a large 
blister applied to the abdomen, and one to the inside of each 
leg, seldom fail of affording the most sensible relief — and 
more especially if preceded by topical bleeding, by means of 
leeches or cupping glasses. To prevent a return of those 
symptoms however, free evacuations must be continued daily 
from the bowels by means of mild purgatives, particularly by 
castor oil given in half ounce doses once in three or four 
hours, mixed with any thing agreeable, that is of a mild na- 
ture, the patient making use of acidulated drinks and the 
antiphlogistic regimen at the same time, and carefully abstain- 
ing from opiates till the acuteness of the griping and inflam- 
matory symptoms have been completely subdued ; after which 
if the tenesmus continues (which in consequence of the abra- 
sion of the rectum is generally the case) opiates are not only 



[y beneficial, and particularly when administered 
Lcikginoui injectu 

When tli i not j ield to these remedies, but the 

griping and tenesmus continue stationary or return soon after 
they have been considerably mitigated, there rs reason to sup- 
ssioned by the retention of soyballs orindu- 
rated exc 'Ion. In such cases the remedy in 

which Sir John IVmglc pis * reliance, was five grains 

unbilled with thirty grains of rhubarb, which in 
ordinary constitutions he says, is a moderate or rather a small 
dose. This combination he adds, renders the rhubarb milder 
in its operation (p. 263 — edition 7th.) This is confirmed by 
Dr. Richter in his Medical and Chirurgical Observations, 
published at Goettingen in 1 T93, who affirms that no purga- 
tive operates so powerfully and at the same time so gently as 
calomel. In such circumstances I have frequently prescribed 
grains of calomel and two of opium at bed time, with the 
most decided success. The opium lulling the pain, while the 
calomel usually occasions a free evacuation next morning. 

Clysters of lintseed tea, a solution of gum in water, thin 
starch and olive oil, are generally employed for the purpose 
of mitigating pain ; but as long as the inflammation of the 
intestines continues they generally add to the torment, unless 
when administered cool — and when the tenesmus is urgent I. 
have generally found them come away immediately, and this 
distressing symptom increased by the attempt to administer 
them, owing to the irritation which they occasion, even in the 
smallest quantity. 



Under these circumstances therefore, and especially in the 
second stage when the strength daily declines and the fever con- 
tinues with dry skin, parched tongue, and frequent ineffectual 



216 

efforts to evacuate the faeces, several of the most experienced 
writers recommend purgatives, combined with opiates, and of 
these Dr. Clark in his Observations on Diseases of Long Voya- 
ges, gives the preference to a combination of calomel and opium, 
in the proportion of from three to five grains of the former to 
two of the latter, which he directs to be taken every four hours 
till they occasion a slight salivation or tenderness of the gums. 
As soon as this is obtained, he asserts that the griping and 
tenesmus both subside ; and observes, that from twenty to 
thirty grains given in this manner, generally have a sensible 
efFect on the mouth, though he has sometimes met with cases 
which required more than a drachm. When this remedy does 
not also operate as a cathartic he interposes a saline purgative 
occasionally to carry off the indurated acrid corrupt humours 
from the intestines.- It is true, Dr. Clark employed calomel 
and opium in every stage and under all circumstances of the 
disease, but the event of several of the cases which he has re^ 
corded, by no means confirms the propriety of this indiscrimi- 
nate and empirical practice. The cases recorded by Drs* 
Yates and M'Lean, in a publication intitled the Science of 
Life, afford ample proof that so long as the acute pain and 
fever denote the presence of inflammation of the mucous 
membrane of the intestines, the free use of mercury combi- 
ned with opium is highly pernicious ;* as an example of this 

* Mr. Hooper in his account of the sick, landed at Plymouth from Corun- 
na, after the campaign in Spain in the year 1808, states, that though he 
salivated men under different circumstances, labouring under the dysen- 
tery, it was of no avail. 

He had no better success from saccharum saturni, given in doses of five 
grains once in five hours, made into pills with confectio aromatic — and af- 
terwards in doses of three grains combined with opium grs. iss. — Two 
grains of opium alone, given every two hours, had no better effect. He 
then increased the quantity of opium gradually to six grains, which he gave 
regularly every four hours for three days, without any perceptible benefit 



-17 

T have transcribed the history of the following case I 
\ i and M 1 Lean's practice. 

On the first of September, a patient in the earlj I the 

oteiy, \\ i tli symptoms of great severity, took tw< 

■lomel and as much opium every two hours. This was 

continued for two days — on tin third day, the dose was given 

every hour; beside which he had half an ounce of mercurial 

ointment with 5j. of calomel rubbed into his body. Next day 

the pills were continued, and the quantity of ointment tripled, 
by three rubbings in. — This was continued for three days, at 
which time an eruption on the skin appearing, it was feared 
he could not be salivated ; this eruption being a sign that no 
salivation could be produced. The same mode of treatment 
however, was persisted in. September 7th, the calomel in the 
pills was augmented to four grains ; the warm bath was used, 
and the ointment with four drachms of calomel applied. — 
\ i \t day though his pulse was almost imperceptible and his 
extremities cold, " the medicines were continued as far as 
circumstances would admit ;" with what view it is not said, 
nor indeed is it easy to be discovered. At one in the morn- 
ing, the patient died : an event, under such treatment, not at 
all surprising. Our authors excuse themselves for this fai- 
lure, by saying the viscera were diseased, as was evinced by 
the impossibility of exciting a salivation, and that when a pa- 
tient is evidently incurable by common practice, it becomes 
the duty of a practitioner to depart from it. — Xo doubt wc 
may readily assent to both these assertions ; but though a pa- 
tient be evidently incurable by the usual practice, or by any 
other, there is no nece^sitv for killing him, or for persevering 
in a course of violent medicines, whicli evidently make him 
worse. 

2S 



218 



The following table exhibits the symptoms of the disease, 
as they kept pace with the medicines taken :— 



Bays of the 
JMonth. 



August 29th, 
Sept. 1st & 2d 

3d 



4th 



5th 
6th 



7th. 

feth. 

9th 
10th 



Medicines taken. 



Ordinary doses of mercu- 
ry and opium. 

Opium and mercury, two 
grains each every two hours, 
beside opiate draughts. 

The opium and mercury 
as before, but now given 
every hour; half an ounce of 
mercurial ointment with grs. 
60 of calomel. 

Pills as usual.— Ointment 
thrice rubbed in with 120 
grs. mercury. 

Medicines as before. 

Medicines as before. 



Pills as before, with 4 grs. 
of calomel. Mercury in the 
ointment increased to oz. ss. 
Warm bath. At night oz.j. 
of mercurial ointment, with 
oz.ij. of calomel. 
Pills. Ointment and calomel 
as before. Warm bath thrice 
At night oz. ij. of ointment, 
withoz.iv. of calomel. 

Medicines of the same 
kind, as many as could be 
taken. 



Symptoms. 



Pain of bowels and frequent 
stools, growing worse. 
Still increasing. 



Stools very frequent, with 
iolent pain in the bowels, ex- 
treme thirst, tongue furred, and 
no sleep. 

Vomiting during the night, 
tongue brown and furred. 

Violent pain in the bowels. 

Extreme pain on pressing 
the arch of the colon, frequent 
stools, profuse sweats, great 
dejection of spirits. 

As yesterday. An eruption 
on the skin. At night inces- 
sant stools, with violent pain 
in the belly, profuse sweats. 



Incessant^slools with violent 
pain, at night with blood. Ex- 
treme debility. 

Stools innumerable, extremi- 
ties cold, pulse scarce to be 
felt. 

Death at one in the morning:. 



"In the year 1735, the dysentery prevailed at Edinburgh, 
in the months of October, November and December, with very 
violent symptoms, but was mortal only to a few. 



" Some physicians at that time, after bleeding and vomiting 
gave their patients small doses of aquilla alba (calomel) once 
a day till their breath began to be tainted, the purging being 
mitigated at the same time by glutinous food and drink, and 
anodyne clysters, which were the more necessary as the intes- 
tines were easily irritated, so that ten grains of rhubarb scarce- 
ly durst be given*" Med, Essays & Observ.Voh 5 p. 29. 



Many , ra this country employ mercury in *mall 

and repeated doses, in the early stage oi \ iokM cases of the <K 

ry, for the purpose of inducing salivation. In this way 
1 have seldom observed it to succeed, but on the contrary 
have several times Been fatal effects result from this practice. 
This might be expected from the almost invariable effects pro- 
duced by mere ur\. in the interval between its first admini- 
stration and its affecting the gums, its stimulating power is felt 
in a quickened circulation, and often in feverish heats. Hence 
in the early and inflammatory stage of dysentery, calomel 

t never to be employed for the purpose of salivating — but 
in protracted cases, when the local and general excitement are 
moderate, its stimulating effects may be in a great measure 
counteracted by the effects of opium ; and when in such cir- 
cumstances it is pushed so far as to affect the gums, the dis- 
ease of the bowels is generally suspended. 

In some cases, ulceration of the tonsils has been occa- 
sioned by mercury, which has terminated in sphacelus and a 
speedy death; in others, the tormina of the bowels have been 
rendered insupportable, and the inflammation converted into 
sphacelus. — But, according to my experience in protracted 
cases, the practice of giving small doses of calomel and opium 
in conjunction, every three or four hours, till its effects on the 
mouth are evident, are not only safe, but frequently successful. 
The best anodyne is a combination of from half a grain to two 
grains and a half of opium, with from twenty to thirty of Dover's 
powder, or the compound powder of ipecacuanha, followed 
by a cup of warm tea, made of hyson, chamomile, or sage, 
every half hour for three hours, or till a copious perspiration 
follows. Calomel given in this manner, operates as a mild 
and effectual laxative ; while the opium combined with the 
ipecacuanha or neutral salt, not only eases the pain but pro- 
motes perspiration, and thereby acts in reducing the inflam 



226 

mation of the internal surface of the intestines, on which I be- 
lieve all the symptoms depend. 

A flannel roller or bandage round the abdomen, has lately 
been highly recommended by several physicians who have 
practised in hot climates in every stage of the dysentery, par- 
ticularly by Drs. "White and Dewar. 

In the East Indies, Dr. Wade gave a dose of calomel every 
night, and a saline purgative the following morning, till the 
disease gave way, and assures us that this treatment generally 
succeeded. 

When the dysentery continues till the strength is much im- 
paired and the pulse sinks while the hectic heats continue, 
great danger is to be apprehended; but so long as there are 
neither involuntary stools, nor aptha?, nor hiccup, the case 
is not entirely hopeless. Under these circumstances, decoc- 
tions of cortex and serpentaria, or of columbo root, with fronj 
five to fifteen drops of laudanum, more or less, according to 
the degree of violence of the griping and pain, in a draught 
of cretaceous julep once in three or four hours, with vinous 
and cordial aliment, in a liquid form, and particularly wine 
whey, are the articles from whence most benefit has been ob 
tained. 

But when the patient has involuntarv stools, apthse and 
hiccup, accompanied with great prostration of strength and 
oppression at the praecordia, the case is desperate, and scarce- 
ly admits of palliatives. 

In the chronic state of the dysentery, an alterative course of 
mercury guarded from occasioning debilitating evacuations, 
the frequent use of the hot bath, a flannel under dress, and a 
tight flannel roller round the towels, or when that does not 
succeed, a successive application of epispastics to the abdo- 



men, with tonic infusions, 01 absorbent mrxturrt, rendered 

cable l)\ cinnamon or nutmeg water, and five or six drops 

tudanum once in four hours, continued day and night, and 
a diet composed chiefly of light animal substances in the form 
of jellies, broths, or infusion ; rice water, arrow root boiled to 
a thin jelly, and rendered cordial with wine and nutmeg, or 
brandy and nutmeg : milk with tin- addition of a small por- 
tion of lime water, or with chalk, gum arabic, and a little cin- 
namon, mace, or pimento boiled in it. 

The following infusion is one of the best tonics and astrin- 
gents for the diarrhcea, which sometimes succeeds the dysen- 
viz. 
1$>. Rad. eolumb. in pulvere crasso Jss. 

Pulv. gallae. alep. sem. cardamom, ana 3ij. 
Spir. vin. com. (proof brandy) Ibj. 
To remain some days in infusion — -then to be strained, and 
from two tea-spoonfulls to a table spoonful, to be taken dilu- 
ted with water, three or four times a day. 



OF THE CHOLERA INFANTUM, 

Or Vomiting and Purging of Infants and Young Children. 



The chief symptoms of this disease are a vomiting and 
purging concurring together, or immediately alternating with 
one another. And the evacuations both upwards and down- 
wards are frequently mixed with bile. 



222 * 

From this last circumstance the disease has received it* 
name. 

This effused bile and other excreted fluids, irritate and 
excite the motions abovementioned. 

When the disease begins with violence, the spasmodic con- 
tractions of the intestines are soon communicated to the abdo- 
minal muscles, and very frequently to those of the limbs* 
In this manner the disease frequently increases rapidly in vio- 
lence, till the strength of the patient is greatly and often sud- 
denly exhausted, while a coldness of the extremities, cold 
sweats, and faintings coming on, an end is put to the patient's 
life, sometimes in the course of a single day. 

In other cases the disease is less violent, continues for a day 
©r two, and then ceases by degrees; though such recoveries 
seldom happen without the assistance of art. 

In many cases of young children the diarrhoea continues 
after the vomiting has ceased, and after harassing the pa- 
tient for many weeks, proves fatal. 

The attack of this disease is not preceded by, or accompanied 
with febrile symptoms, and though during its course, both the 
pulse and respiration are frequent and irregular, yet these 
symptoms are generally so entirely removed by the remedies 
that relieve the spasmodic affections peculiar to the disease, as 
to leave no ground for supposing that it depends on the same 
condition of the system as idiopathic fever. 

Dr. Sydenham observes that the cholera in England is 
chiefly prevalent in the month of August, and that the vio- 
lence of the disease is in proportion to the heat of the air. 



Philadelphia i ralent in the teonth of .Inly, 

eqttently occur in June, August and September. 

^instances, and from the Facta stand bj 
tropica] writers, it appears evident thai a hot atmoaphen 
the predisposing cause of this disea 

The chief of the exciting causes appears to be. a sudden 
change in the temperature of the atmosphere, for it is alw ays 
most prevalent, when alter extreme hot and dry weather, a 
of rain has suddenly cooled the atmosphere. 

In some cases after the heat of the season has given the 
predisposition, the disease is induced by eating too freely of 
crude vegetables, and such substances as are of difficult 
digestion. 

Emetics of the drastic kind are very apt to induce thi c - 
disease when employed during the hot season. 

Though the effusion of bile into the alimentary canal is fre- 
quently an exciting cause of the disease at first; it often 
continues after the bile is completely evacuated, owing to the 
debility and exquisite irritability, induced by the action of 
vomiting. This is similar to what happens after taking an 
over dose of tartar emetic ; the vomiting often continuing 
after every particle of the emetic which first excited it, has 
been evacuated. 

The pores of the skin being relaxed and enlarged by the 
summer's heat, and accommodated to the increased quantity 
of perspirable matter, which is determined thither and ex 
haled, any plethora occasioned by a diminution or suppression 
of that discharge, must overload the viscera of the abdonKU 
whose ordinary secretions are most languid at that time. 




224 

The consequence of this determination is a distention of the 
vessels of the abdominal viscera^and of course irritation and 
pain, and this irritation and pain occasion an increase of their 
secretions. 

The bile, and the pancreatic fluid, as well as the gastric 
fluid, appear to be more acrid in this disease than in a state of 
health : hence the application of these, or of any other acrid 
substance to the debilitated and irritable fibres of the stomach 
and intestines, occasions those enormous and irregular mo- 
tions in their fibres, which have been described. 

These convulsive motions sometimes exhibit an appearance 
of increased power, as well as of action ; but this appearance is 
fallacious, otherwise sedative or debilitating and not stimula* 
ting remedies would afford relief. 



TREATMENT. 

In every case of cholera, the bilious and other acrid matters 
contained in the stomach and intestines should be immedi- 
ately diluted, and carried off by large and frequent draughts 
of weak chamomile tea or warm water with two grains of 
pearl-ash dissolved in every ounce, and when the patient will 
submit to them, by injections of the same with the addition of 
olive oil. 

As soon as this is accomplished, or sooner, if the spasms 
have begun to affect the limbs, recourse should be had to the 
internal use of opium, which should be administered in a 
liquid form by the mouth, if the stomach will retain it. To 
an infant from on? to twelve months old from one to four 
drops with the same number of the essence of peppermint 



should be riven insugarand water, and repeated every hbui 

tamed on die stomach, till the evacuations and spasms 

, but if ild be repeated immediately 

after evi lation, and also frequently by injection in 

larger doses. The laudanum should be pr o portioned to the 

patient's age and vigour: to a child from one month tb a 

, from one to four drops will be proper, repeated as 

above directi d. 

To render the laudanum more certainly effectual, every 

means should he employed to restore the determination to 
the surface. For this purpose, when practicable, the patient 
should be immersed in the warm bath, but where that is im- 
practicable, double flannel cloths wrung out of hot water 
should be applied to his stomach, abdomen and limbs, as hot 
as he can convenientlv bear them, and the application of the 
flannel cloths should be repeated as often as they become 
cool. 

These failing, from four to twelve drops of laudanum should 
be thrown up the howels, in a clyster of chicken broth, rice 
gruel, or chamomile, and fennel-seed tea, or any other simple 
liquid, moderately warm ; and should be repeated every two 
hours, or after every evacuation, till the symptoms cease. 

If the disease should continue, notwithstanding the judi- 
cious application of the remedies which have been directed, 
blistering plasters, or sinapisms should be applied to the sto- 
mach and inside of the legs, and the whole of the spine rubbed 
with mustard, mixed with the spirits of sal. vol. ammon. or a 
mixture of the oil of cloves, volatile spirits and sweet oil, and 
the patient should have his feet and legs kept warmer than 
usual, the doors and windows of his chamber being open, 
if the weather is dry, for the benefit of fresh air. 

29 



226 

In some cases, double flannel cloths sprinkled with \varto 
spiced brandy, or a mixture of oil of cloves, volatile spirits 
and brandy applied to the stomach and bowels, and a common 
heated flat or smoothing iron passed over the flannels have 
afforded speedy relief. 

In some cases, ether exhibited in doses of three or four 
drops in any simple herb tea or mucilage, and frequendy re- 
peated has succeeded when opium has failed. 

This disease is very liable to return the day following, 
unless prevented by suitable remedies. The remedies which 
I have found most efficacious for this purpose, have been the 
tincture of opium combined with a weak mixture of gum 
arabic and water, with the addition of calcined magnesia, or 
the carbonate of soda and the essence of peppermint, given in 
small doses at intervals, of four, six or eight hours, and conti- 
nued for three or four days, after which the patient should take a 
weak infusion of Columbo root and cinnamon or nutmeg, 
with the addition of a small quantity of spirituous cinnamon 
water or old brandy four or five times a day, to restore 
tone and strength to the exhausted stomach and intestines. 

During the state of convalescence, the lightest and most 
grateful food should be taken in a small quantity at a time, 
such as fowl broth, beef tea, boiled milk, rice gruel, sago, &c. 

In general, adult patients soon recover perfectly from this 
disease, if managed agreeably to the preceding directions and 
the remedies are given in proportionable doses ; but with in- 
fants and young children, the diarrhoea with occassional vomit- 
ing, is very apt to continue obstinate for a great length of 
time, and in general proves more fatal to them than any other 
disease to which they are liable. 



im thai tlu term Cholera 
■ be confined. I shall th< i I to 

tption of the Chol< ra in i 
aic form under the appellation of the 

Chronic Cholera, or Bilious Diarrhgca of I 

'» ( ' 1 1 1 1 . i > i 

ib much more prevalent in cities and popu- 
lous towns than in country situations, and its occurrence like 
the common cholera morbus is chiefly confined to the warm 
months of summer and autumn. 

Its principal subjects are infants at the breast, and chilcirc;. 
rars of age. 

In Philadelphia, New-York, Baltimore and Charleston, 
more children are annually destroyed by this disease and the 
cholera in its acute form, than by all the other diseases to 
which they are subject in this variable and unsteady climate. 
Hence an acquaintance with the most successful methods ol 
treating it, is of the highest importance to the community. 

This disease is generaH) the consequence of an imperfect 
recoyery from an attack of the cholera morbus, in its acute 
and common form. It howeyer frequently comes on without 
being preceded by cholera after a sudden change of tempera- 
ture in the atmosphere, affecting those chiefly, who have been 
exhausted by the preceding heat of the season, and the impure 
state of the atmosphere of cities or populous towns, and of 
low and marshy situations in the country. 

It is distinguished from the diarrhoea, which occurs at othei 

ons, or that arises from indulging too freely in unripe 

fruit or other fermentable and irritating aliment, by the sere* 






228 

rity of the griping, and the bilious, yellow, or green colour ot 
the stools, and by being accompanied with sickness of stomach 
and vomiting or a propensity to vomit immediately before 
every stool ; and it is distinguished from the acute cholera 
morbus, by the greater length of time between the eva- 
cuations. 

It may also be distinguished from the diarrhoea which fre- 
quently accompanies teething, by the difference in the strength 
of the pulse, temperature of the skin, power of muscular exer- 
tion or voluntary motion, and in the aspect of the counte- 
nance. In the latter case, these differ but little from their 
natural state, for several days after the commencement of 
the disease, and the evacuations are watery or slimy, and 
but seldom discoloured by the addition of bile, whereas in 
the bilious diarrhoea, which occurs in the hot season, uncon- 
nected with teething, the sickness of stomach is frequent, and 
the debility in most cases very considerable from the com- 
mencement of the disease. The pulse is quick and small, or 
low and soft, the skin cold and dry especially on the limbs, 
the features appear to be shrunk, the countenance pale or 
livid, and the eyes dull and inanimate. The thirst increases 
as the disease proceeds, the flesh wastes daily, all kinds of 
aliment are loathed and refused, excepting breast milk. No 
drink but cold water is grateful-, and that is thrown up soon 
after it is swallowed. 

All the enumerated symptoms generally continue to increase 
daily, till the patient breathes his last, unless relieved by judi- 
cious nursing and appropriate remedies. In dangerous cases 
the evacuations become more copious and frequent, m some 
rapidly, in others more slowly ; the stomach loses its digestive 
power, every thing taken into it, soon after, passes through 
the intestines undigested, or but little altered in its texture. 
The thirst becomes insatiable ; the mouth and tongue covered 



frith aptlua, at with small white as or ulcetattontj 

'U's llu abdomen 

t< nded with air, the skin livid, and « >ften spotted cm 

! with dark coloured bl r the cuticle; 

patient lies oomatoae and insensible, with his eyelids hali 

n and his eyes turned upwards. When reduced to this 

deplorable condition his days may be ( I .is numbered 

and is de.itli approach; 

The duration as well as \ iohiueol this disease 1 - very va- 
rious: some recovering in the course of a week or ten 
ale others linger lor months, and though so ema- 
ciate J. as to resemble skeletons, at length recover; while the 
majority die in the course ot the third or fourth week ; many 
after lingering six or seven, and some after a much longer 
od. 

From the preceding view of the disease, it appears that the 
griping or spasmodic affection of the alimentary canal is occa- 
sioned by the introduction of irritating matters into it, either 
in the form of aliment or drinks, or by the colluvies poured 
into the intestines from the pancreatic and biliary ducts, and 
from their own exhaling and secretory vessels. The ex- 
cretories from which the greatest quantity of liquid matter is 
effused into the intestinal canal, are those of the intestines 
themselves, and are either the exhalents proceding directly 
from the extremities of the arteries, or the mucus follicles ; 
both of which occur in prodigious number over the internal 
surface of the whole intestinal canal ; it is therefore probable 
that it is chiefly the effusion from these sources, in most in- 
stances, that die matter of the liquid stools is derived. 

Hence it appears that the matter effused into the intestines, 
by which the griping and alvine evacuations are occasioned, 



230 

is owing to too forcible a determination of the circulating 
fluids to the intestines and other abdominal viscera, previ- 
ously debilitated, and rendered morbidly irritable by the 
operation of the remote causes. 

TREATMENT, 

As this disease depends principally upon a debilitated and 
disordered state of the abdominal viscera, and especially upon 
an atonic and morbidly irritable state of the exhalent and se- 
cretory vessels of the stomach and intestines, produced by the 
debilitating operation of the remote causes and particularly 
by the relaxing and exhausting effects of the high temperature 
which predominates during the summer and autumnal months, 
in conjunction with the impurity of the air; and the subse- 
quent torpor produced upon the vessels of the external surface 
of the body, by a sudden change of temperature, and in many 
cases, by the exhaustion produced by previous vomiting, and 
as the griping or painful spasmodic or convulsive motion of 
the intestines, and the frequent and copious liquid evacuations 
by stool, accompanied with sickness and vomiting, or inclina- 
tion to vomit, are occasioned by the heterogeneous and irri- 
tating colluvies, that is poured into them from the pancreas and 
liver, and from the exhalents and glands w T ith which the sto- 
mach and intestines are themselves so plentifully supplied j 
by the stimulating impression of which, the spasmodic mo- 
tions of the intestines is produced,, we are not to expect to 
remove the disease by merely scowering out the intestines by 
means of purgatives ; for though purgatives, may remove the 
colluvies already collected in them, they must in some degree, 
augment and enlarge the source from whence the irritating 
colluvies is derived. 

But the cause which induces and supports this effusion of 
irritating matter into the intestines, being an undue determi- 



n oi the circulating fluids to thi and ali- 

mentary canal, and a morbid state i I 

if the preternatural resistance 
which the circulating fluids meet with from the torpor or 

triction of th distributed over die ( ur- 

face of the body. The indii of cure, are, after clearing 

the ground by a suitable emetic and cathartic, to make- way 
for the operation oi excitants and tonics, to withdraw the force 
of the circulation from the internal, ami to direct it to the cx- 

:l surface of the body, and there to support it, while ap- 
propriate means are employed to restore and establish the 
tone, and healthy action of the stomach and intestines, and of 

i zhaling and secretory vessels, widi which they are sup- 
plied. 

An emetic has the effect not only of evacuating the contents 
of the stomach, and thereby clearing the ground for the ope- 
ration of other remedies, but of determining the fluids to the 
rnal surface of the body, and thereby assisting in accom- 
plishing one of the principal indications in the cure of this 
ise ; it is therefore a remedy that ought generally to be 
employed at an earl)' stage of the disease, if the patient has 
sufficient strength to render its operation safe ; and may be oc- 
casionally repeated while the strength will admit, and the de- 
termination to the bowels, requires such a remedy. The 
emetic which I prefer on these occasions, is ipecacuanha, 
which 1 generally direct to be administered agreeably to the 
following prescription. 

§>. Pulv. ipecacuanha? 3j. 
Aqua? communis Jj. 
Sacch. alb. 5j. misee. 
Of this mixture, two tea-spoonfulls maybe given to a young 
infant, and half as much repeated every quarter of an hour, 
till it begins to operate ; after which a little warm water, co- 
loured with milk, barley water, or Weak balm tea, may be 




232> 

given frequently, till it has done operating ; after which tnc 
little patient should be immersed in a vessel of warm water, 
then wiped dry, take an anodyne suited to its age and strength, 
and be laid in bed with its feet and legs covered with flannel 
or soft muslin. The object being to produce perspiration, all 
the drinks should be given warm, till that makes its appear- 
ance ; after which, in order to support the determination to 
the surface, and to divert it from the intestines, the emplas- 
trum calidum should be applied to the abdomen, wrists and 
ancles, and should be continued on, till it raises vesications- 
on the skin ; or if these should be thought more severe than 
the urgency of the case requires, the common gum or Burgun- 
dy pitch plaster may be applied to the abdomen, and a little 
powdered ginger, and oil of cloves mixed with unguent, basi- 
licon to the wrists and ancles. When the symptoms indicate 
the existence of considerable debility, cordials and stimulants 
are the only remedies of much avail ; though when the stools 
are green, curdled and frothy, the cretaceous julep, with the 
addition of a small quantity of cinnamon water, or anniseed 
water, and a very small quantity of tinct. opii. in each dose is a 
useful auxiliary, as it serves to correct the irritating acid 
which usually abounds, and to ease the griping or spasmodic 
affection of the intestines at the same time.— Wine seldom 
agrees ; but spiced brandy copiously diluted with water, or hot 
brandy toddy, rendered agreeable by the addition of powder- 
ed nutmeg generally agrees, and if given of proper strength is 
frequently beneficial ; though I have found strong anniseed 
water or cinnamon water more grateful and equally effectual, 
mixed with a sufficient quantity of water and sugar. It has 
been found particularly serviceable, to give a little warm 
watery infusion of cinnamon, cardamom, anniseeds, or fennel 
seeds, as well as the cretaceous anodyne mixture, after every 
evacuation. When the restlessness and distress of the child 
appears to proceed from wind, distending its intestines, a 
small clyster of moderate warmth, made of lintseed tea or bar- 



233 

ley water, with the addition of two ot three drops of the oilof 
anniseed, or i i peppermint, and half a table spoonful! 

oil, will generall) i an evacuation and | 

immedii or a Btrong infusion <>1 the Bowers of the lu- 

polus humulus or common hops, may be substituted, and 
from five to twenft) drops of a spirituous tincture oi' the same 
maybe given by the mouth every fifteen or twenty minutes, 
mixed with a sufficient quantity ot* warm water, sweetened 
with sugar, in lieu of the more narcotic class of anodynes. — 
hop tincture may be prepared by infusing half an ounce 
of the flowers in eight ounces of brandy for a week or ten 
days . after which the liquor should be strained off and kept 
in a bottle with a glass stopper. In mild cases of cholic, the 
infusion of hops is to be preferred to other anodynes, because 
it usually operates as a purgative, at the same time that it miti- 
gates pain connected with spasm — but in more severe cases of 
the cholic of young infants, there are no remedies equal to 
warm mucilaginous and oily injections, and the cautious use 
of an alkalescent aromatic mixture, similar to that called 
Dalby's carminative. 

When an injection cannot be conveniently administered, a 
veak infusion of coarsely powdered rhubarb and calcined 
magnesia in boiling water, with a due proportion of cardamom 
or coriander seeds, and the flowers of hops should be substi- 
tuted and given by the mouth every hour," till it has the desi- 
red effect of passing through the intestines, and carrying off 
the confined flatus and other extraneous matters ; after which 
immediate recourse should again be had to mildly stimulating 
and invigorating agents. 

Under the circumstances first mentioned, mild evacuants 
are not only safe, but have been found by experience abso- 
lutely necessary to carry off the extraneous matters, which 

30 



234 

If permitted to remain, would prove a source of irritation, as 
well as m echanical obstruction to the operation and influence 
of exciting and invigorating remedies. These remedies, if 
duly persisted in, very frequently subdue, or at least suspend 
the disease, and make way for the employment of tonics, 
which should then be employed in conjunction with the usual 
cordial, and aromatic stimulants. Of the tonics, I give the 
preference to the bark m decoction eombined with cinnamon, 
cardamom seeds, or a very small quantity of any other agree- 
able spice* 

The tincture of gum kino, may also be given in some 
agreeable aromatic infusion or mixture ; or in the cretaceous 
mixture, which is recommended by Mr. Ring, an ingenious 
practitioner in London, to be prepared in the following man- 
ner, viz. 

$>. Cretse. ppt. Qiv. 

Pulv. gum arab. Qij. 
Aquae distillat. Jij. 
Aq. cinnam. simp. gss* 
Sp. cinnam. 3ij. 
Sach. alb. par. 3ij. misce.* 
The child to take from one to four tea spoonfulls according 
to its age, once in four hours, and also after every stool. 



To each dose of this, may occasionally be added, to relieve 
griping, from one-fourth of a drop to two drops of laudanum, 
and to strengthen the stomach, from five to fifteen of the tinc- 
ture of gum kino, or twice as much of a spirituous tincture of 
the common ink galls. 

"When the debility is very great, and the griping or cholic 
pains require the use of laudanum, it should always be given in 
very small doses, and she aid seldom be repeated in such cases, 

* London Medical and Physical Journal, vol. xii. p. 106. 



utter reiki h obtained by it, in less than four hours. From 
neglect of this precaution, numbers have been more injured 
than benefitted by it. 

Wh id exists, which is known by the 

ools, and th< acid 
eructation icuationa by vomiting, calcined magnesia is 

pi e fe tabl on account of its being deprived of its 

he common vegetable alkali, on ac- 
count c I iter mildness. 

In such circumstances, therefore, the following mixture 
should be substituted in the place of the cretaceous mix- 
ture : 

§,. Magnesia calcinat. j)iv. 

Pulv. gum arabic 9ij. 

Sacch. alb. pur. 31J. 

Aq. cinnam. simp. vcl. 

Aq. menth. pip. §ss. 

Aq. communis 5\jss. misce. et adde, aquae am- 
monias purse (commonly called volatile spirits of sal ammo- 
niac), from forty-eight to one hundred and forty-four drops, 
according to the age of the patient. To the above may occa- 
sionally be added, the same number of drops of the essence 
of peppermint as of the ammonia, and from one fourth to two 
drops of laudanum to every dose. 

From one to two tea spoonfulls of the preceding composi- 
tion, should be given regularly every half hour till the griping 
ceases or is suspended, and afterwards every third or fourth 
hour, mixed with warm water, sweetened sufficiently with 
best white sugar. 

The same medicine should also be given in diminished 
doses after ever}- evacuation, observing to administer anodyne 
mucilaginous injections occasionally, to relieve griping anif 



236 

the spasm of the bowels, and to have recourse in more dan- 
gerous cases to the warm bath, and the external application 
of laudanum mixed with warm brandy, or camphorated spi- 
rits. Though the corrosive acid in the stomach and bowels 
is not the primary cause of the griping and purging, it is the 
exciting or efficient cause, and therefore requires such reme- 
dies as have the effect of neutralizing it. 

Magnesia has long been in great repute as a remedy in the 
griping and green purging of infants and young children, 
but its efficacy is very much improved by the addition of 
pure ammonia, as the effect will be nearly the same without 
the magnesia; but the magnesia will not have so certain an 
effect without the ammonia. 

Experience also proves, that no other alkaline substance is 
of sufficient efficacy in neutralizing the existing acid in the 
stomach as the alkalies in a volatile state. From this circum- 
stance, it is probable the spasmodic effects, produced by the 
acid in the stomach and intestines, arises from the acid being 
in a gaseous state, more than from their liquid contents. This 
■acid gas is probably neutralized by the alkaline gas, into 
which the water of pure ammonia is supposed, by Mr. Pear- 
son, to be converted by the heat of the stomach. 

That the carbonates of ammonia do not succeed so well 
may be owing to the greater attraction of the carbonic acid 
for the alkali, than that of the acid gas in the stomach and in 
testines. Whether this explanation is just or not, the supe- 
rior efficacy of the volatile alkali has been long established ; 
and was taught more than twenty years ago by Dr. Kuhn, in 
his lectures delivered in the University of Pennsylvania. 

"When the child is unable to raise its head from the pillow, 
or to be held up, and its features appear contracted an.d 



137 

¥ Beem inanimate, or when it keeps them 

open and turned upwards, and a livid tin le appears around 

them, th. nance being of a pale livid colon ipa- 

w ith great prostration of strength, danger in the high. 
degree is indicated* 

In these Cf u nation from the bowels, is ;■ 

ceded bj at stomach, griping and pain, which are de- 

noted bv the moaning, restlessness, and tossing about of the 
arms, and rolling of the head from side to side. Under these 
circumstances, our principal resource is in mucilaginous clys- 
ters, composed of thin arrow root, or rice boiled to a jelly, or 
diluted calves' feet jelly, and infusions of the common aroma- 
tic spices, Sec. to which may be added, from one to four drops 
of laudanum, or eight times as much tinct. opii. camphorat. 
formerly called paregoric elixir, observing to apply blisters or 
other stimulants externally to the abdomen and limbs at the 
same time, and to keep his body and limbs surrounded with 
soft flannel, without regard to the temperature 01 the season; 
supporting the strength in the mean time, with such refresh- 
ing nourishment as the child can take, either by the mouth or 
by injection. If these means should have the desired effect 
of suspending or moderating the disease, the patient should, 
if possible, be immediately removed from the hot and insalu- 
brious air of the city, to the cooler and purer air of the coun- 
try, and remain there until perfectly recovered. For we 
might with equal reason, expect to cure an inflammation of 
the eyes occasioned by a smoky room, without a change of 
situation, as to make a complete cure of the bilious purging 
of infants and young children, so long as the heat and impu- 
rity of the air, which gave origin to the disease continue to 
operate. 

D the child appears to be rendered restless by painful 
spasms of its intestines, or by distension from confined air, 



I ♦ 



233 

temporary relief may generally be obtained by a small injec- 
tion, made of flaxseed and fennelseed infused in boiling wa- 
ter, to which a small quantity of fresh olive oil, and two or 
three drops of the oil of anniseed should be added, and the 
same repeated as often as these symptoms return. 

Removal to the high grounds of the country, sufficiently 
remote from marshes, ponds, or mill-dams, to prevent any 
injurious effect from such sources before the extreme heat 
commences, is the bfest preservative against the cholera and 
bilious diarrhoea of infants, and young children ; and removal 
to the country, after the disease has occurred, as soon as its 
symptoms are suspended, is the most certain method of resto- 
ring the patient to health. 

The diet of the patients should consist principally of 
breast milk, care being taken that the nurse subsists on mild 
nutriment, consisting principally of animal substances, and 
avoids all kinds of spirituous liquors, excepting a small quan- 
tity of sound porter, or weak sangree, made of Madeira or 
port wine, with the addition of grated nutmeg,, and avoids 
every kind of purgative by which the milk can be affected. 
Breast milk, and in cases where the child is weaned , a thin 
decoction of the West India arrow root, in milk and water, made 
palatable with grated nutmeg and double refined loaf sugar, 
or of rice prepared in the same manner, will be proper ; and 
in cases of lientery, and loss of tone of the digestive organs, 
very weak punch, made with rennet whey, instead of milk, 
rendered palatable by the addition of double refined su- 
gar and nutmeg; and when acidity and flatulency abound, 
beef tea or chicken water, with whole pepper, mace, or pi- 
mento boiled in it, and seasoned lightly with salt, have been 
found most beneficial. 



"When cow's milk is used, it should always be boiled with 
kwjce as much wan r, and may be rendered move beneficial by 

the addition of one eighth part, or tenth part of linn- water, 
and a little loaf sugar, as with that addition it neutralizes the 
existing acid, and give* tone to the debilitated fibres of the 
stomach. 

die analysis of women's and cow's milk, sec Thomas's 
unci Elerdman's Abstract of the experiments of Dr. Clark ot 
Dublin ; from which it appears, that the milk of a healthy 
woman agrees better with a weak stomach, as it scarcely 
curdles when mixed with a strong ackl, as well as with the 
stomach of an infant, than any other substance. "Whereas, 
the milk of a cow, before the curd is separated, is one of the 
worst and most improper kinds of food that can be taken into 
a debilitated stomach abounding with acidity. 

The whey, however, of cow's milk, which is made by mix 
ing a small quantity of rennet, (a portion of the dried stomach 
6f a calf) with it, previously warmed, bears a near resemblance 
to the milk of a healthy woman, and may occasionally be sub- 
stituted for it. 

Cases of diarrhoea often occur in summer that are not bili- 
ous, particularly in the month of June and the early part of 
July. In these cases the alvine evacuations, are usually more 
or less mixed with mucus, and are sometimes tinged with 
blood, the purging though-more frequent is attended with less 
griping, and the evacuations are less in quantity; the counte- 
nance is more animated, the eyes more bright, and the mus- 
cular debility and sickness at stomach less evident and dis- 
tressing. 

Children, whose gums are inflamed by the process of teeth- 
ing, are most frequently the subjects of this kind of diarrhcea i 



240 

and my observations lead me to conclude, that the effects - of" 
teething, instead of being the cause of the bilious diarrhoea is 
generally a preventative, except the inflammation occasioned 
by the teeth before they pass through the gums, be so great 
as to induce indirect debility. 

To relieve the diarrhoea, which is occasioned by teething,- 
an incision should be made through the swelled and inflamed 
gums, so deep as to reach the advancing teeth, which will 
prevent any further irritation from that cause. The irrita- 
tion and pain occasioned by teething, frequently renders the 
stomach liable to be disordered by every thing the infant 
swallows ; under these circumstances, gentle purgatives, such 
as calcined magnesia or oleum ricini, in the day time occa- 
sionally repeated, and a sufficient anodyne at night, eithef by 
the mouth or by injection, to insure sleep, are the remedies 
which I have experienced to be most efficaeious in affording 
relief. 

Calomel has been employed by some physicians, and. re- 
peated daily for several days, as a remedy in the green and 
watry purging of infants, and among others by Dr. Clark of 
Dublin, and Dr. Cheyne of Leith, from an idea that the di- 
sease depends upon a deranged state of the functions of the 
liver, and they have reported in its favour ; but I could ne- 
ver reconcile it to my conscience to make trial of a remedy in 
a disease, in which an increase of debility is the circumstance 
most to be guarded against, the primary and direct effect of 
which remedy, is to increase the evacuations already too co- 
pious, and to reduce the strength of the patient already too 
much exhausted. 

THE END. 



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